乌司他丁预先给药对下肢手术患者松止血带后肺换气功能的影响

Effect of ulinastatin pretreatment on pulmonary gas exchange following tourniquet deflation in patients undergoing lower extremity surgery

目的评价乌司他丁预先给药对下肢手术患者松止血带后肺换气功能的影响。方法择期单侧下肢手术患者（需要止血带）27例，年龄25—64岁，体重指数18～28kg／ml，ASAⅠ或Ⅱ级，止血带充气时间1．0～1．5h。随机分为2组：对照组（C组，n=15）和乌司他丁预先给药组（U组，n=12）。于L2,5或L3,4间隙行脊椎-硬膜外联合阻滞。U组静脉输注乌司他丁6000U／kg（溶于100ml生理盐水，10ml／min），C组以等量生理盐水替代，均于10min后扎止血带。于扎止血带前即刻（T0）、扎止血带60min（T1）、松止血带后30min（T2）、2h（T1）、6h（T4）和24h（T5）时采集桡动脉血样行血气分析，测定血浆丙二醛（MDA）、血清白细胞介素6（IL-6）和IL-8的浓度。结果与R时比较，C组T4时动脉血氧分压降低，肺泡-动脉血氧分压差和呼吸指数升高，T2-5时血浆MDA浓度升高，L3-5时血清IL-6和IL-8浓度升高，U组T3,4时血清IL-6和IL-8浓度升高（P〈0．05或0．01），各时点血气指标比较差异无统计学意义（P〉0．05）。与C组比较，U组动脉血氧分压升高，肺泡-动脉血氧分压差、呼吸指数、血浆MDA浓度、血清IL-6和IL-8的浓度降低（P〈0．05或0．01）。结论乌司他丁预先给药（6000U／kg）可有效改善下肢手术患者松止血带后肺换气功能，其机制可能与抑制氧自由基脂质过氧化反应和全身炎性反应有关。

Objective To evaluate the effect of ulinastatin pretreatment on pulmonary gas exchange following tourniquet deflation in patients undergoing lower extremity surgery. Methods Twenty-seven ASA Ⅰ or Ⅱ patients, aged 25-64 yr, body mass index 18-28 kg/m^2 , whose tourniquet inflation duration varied from 1.0 h to 1.5 h, scheduled for unilateral lower extremity surgery, were randomly divided into 2 groups： control group （group C, n = 15） and ulinastatin pretreatment group （group U, n = 12） . The combined spinal-epidural anesthesia was performed at the L2,3 or L3,4 interspace and a radial artery catheter was placed for sampling. Patients in group U received iv infusion of ulinastatin 6 000 U/kg while patients in group C received equal volume of normal saline instead 10 min before tourniquet inflation （10 ml/min） . Radial arterial blood samples were collected immediately before tourniquet inflation （To, baseline）, 1 h after inflation （T1） and 30 min （T2）, 2 h （T3）, 6 h （T4）, and 24 h （T5 ） after tourniquet deflation for blood gas analysis and measurement of plasma malondialdehyde （MDA） and serum IL-6 and IL-8 levels. Alveolo-arterial oxygen partial pressure difference （PA-aDO2 ） and respiratory index （RI） were calculated. Results Compared with the baseline values at T0 , PaO2 at T4 was significantly decreased, while PA-aDO2 and RI at T4 and the levels of plasma MDA at T2-5 and serum IL-6 and IL-8 at T3-5 in group C, and the levels of serum IL-6 and IL-8 at T3,4 in group U were significantly increased （ P 〈 0.05 or 0.01 ） . All the changes mentioned above were significantly mitigated in group U compared with group C （P 〈 0.05 or 0.01 ）. No significant changes in arterial partial pressure of carbon dioxide （ PaCO2 ） were observed within and between groups （ P 〉 0.05）. Conclusion Puhnonary gas exchange impairment following tourniguet deflation could be attenuated by ulinastatin pretreatment （6 000 U/kg） via inhibiting lipid peroxidation and systemic inflammatory response.