长托宁对老年患者单肺通气所致肺损伤的保护作用

The protective effect of penehyclidine hydrochloride on lung injury induced by one-lung ventilation in elderly patients

目的:了解对老年开胸患者使用长托宁在单肺通气(OLV)时的炎性反应中对动脉血氧合的作用。方法:选择45例择期行食管癌根治术患者,分为3组,A组为长托宁组,B组为阿托品组。C组为生理盐水组。记录术前及T_1、T_2、T_3、T_4、的生命体征、呼吸力学指标,血气分析,测定桡动脉血TNF-α和IL-6浓度,测定术前及术后72 h肺功能,观察术后72 h并发症。结果:(1)与A组比较,在T_1时仅B组患者HR增高,差异有统计学意义(P<0.05);(2)在T_2、T_3时,与A组比较,C组Ppeak及Pmean升高,差异有统计学意义(P<0.05);(3)与A组比较,B组和C组的PaO_2在T_2和T_3时降低,差异有统计学意义(P<0.05);(4)在T_2、T_3、T_4时,与A组比较,B组和C组的TNF-α和IL-6浓度均升高,差异有统计学意义(P<0.05);(5)术后72 h测定肺功能,3组患者与术前相比均显著降低,但3组患者之间差异无显著性;(6)术后72 h随访有无咳嗽、气短、胸痛、发热高于38℃等征象,无统计学意义。结论:在老年患者开胸手术前使用长托宁,可以提高OLV时的动脉血氧合,减轻OLV时肺的炎性反应,具有一定的肺保护作用。

Objective To investigate the effect of enehyclidine hydrochloride on arterial oxygenation in elderly patients with inflammatory response induced by one-lung ventilation （OLV）. Methods 45 patients undergoing OLV were randomly assigned to receive penehyclidine hydrochloride （group A）, atropine （group B）, or normal saline （group C）. Vital signs, parameters of breathing mechanics, blood gas, and serum levels of TNF-α and IL-6 were measured at baseline and four different time points after surgery. Pulmonary function was measured at baseline and 72 hours. Postoperative complications at 72 hours were observed. Results As compared with group A, HR increased in group B at T1 （P 〈 0.05） ; Ppeak and Pmean elevated in group C at T2 and T3 （P 〈 0.05） ; levels of TNF-α~, IL-6 increased in groups B and C at T2, T3, and T4 （P 〈 0.05）; while PaO2 decreased in groups B and C at T2 and T3 （P 〈 0.05）. As compared with the baseline, postoperative pulmonary function at 72 hours declined remarkably in all three groups but did not differ significantly among them. There were no significant differences in the incidences of cough, dyspnoea, chest pain, and fever above 38℃ among the three groups at 72 hours. Conclusions In elderly patients undergoing onelung ventilation, preoperative penehyclidine hydrochloride has a protective effect on the lung by enhancing arterial oxygenation and reducing pulmonary inflammatory response.