乌司它丁治疗开胸手术中行单肺通气的老年患者15例

Protective Effects of Uulinastatin on Pulmonary of Elderly With Unilateral Ventilation During Operation

目的观察乌司他丁对老年患者在单肺通气下行肺部手术治疗中的肺保护作用。方法 30例择期行肺叶切除术患者随机分为两组,对照组(n=15):乌司他丁组(n=15):术前静脉注射乌司他丁10 000 U/kg。麻醉诱导插双腔气管导管,分别于麻醉前(T0)、麻醉诱导后30 min(T1)单肺通气后30 min(T2)、单肺通气后90 min(T3)、术毕双肺通气30 min(T4)、胸内操作结束后2 h(T5)、术后24 h(T6)7个时点记录MAP、HR、取桡动脉血测定超氧化物歧化酶(SOD)、丙二醛(MDA)及IL-8。结果 T1时点组患者血浆SOD活性均下降,MDA产生增加。对照组SOD活性于T3、T4、T5明显高于术前水平(P<0.05),差异有显著性。乌司他丁组在SOD活性水平于T4、T5点高于对照组(P<0.05),差异有显著性。对照组和乌司他丁组的MDA含量在T4、T5点均明显高于术前水平(P<0.05),差异有显著性,且乌司他丁组于T3、T4、T5点明显高于对照组(P<0.05),差异有显著性。对照组IL-8于T3、T4、T5时均显著升高(P<0.05),乌司他丁组T3、T4时也较T0显著增高(P<0.05),但于T4、T5时明显低于对照组(P<0.05)。结论乌司他丁可以减少行胸科手术的老年患者单肺通气时氧自由基的产生及炎症因子的释放,可能有助于减轻炎性反应对肺的损害。

Objective To explore the protective effects of ulinastatin on the pulmonary of elderly patients with unilateral ventilation during operation. Methods Thirty patients（aged 65-75） with pulmonary carcinoma（in ASA Ⅱ-Ⅲgrade）,undergoing unilateral pulmonary lobectomy with unilateral pulmonary ventilation,were randomly divided into control group（group C,n=15） and experimental group（group U,n=15）.Patients in group U received ulinastatin before general anesthesia,while the control group received normal saline.Blood samples were taken before general anesthesia（T0）,and at 30min after intubation（T1）,at the time points of 30 min and 90 min after unilateral lung ventilation（T2 and T3） and 30 min of bilateral lung ventilation（T4）,2h after operation in the cavitas thoracis（T5） 24 h after operation.The SOD,MDA and IL-8 were calculated. Results SOD decreased significantly in group C at T3-5（P0.05）and there was no significant changes in group U as compared with the baseline values（T0）.MDA increased significantly at T3,4 in both groups.SOD in group U is higher than that in group C at T3,4（P0.05）and MDA in group U is lower than that in group C at T3-5（P0.05）.IL-8 in group U is lower than that in group C at T4,5（P0.05）.Conclusion Ulinastatin can play a protective role in eldly with unilateral pulmonary ventilation by inhibiting the generation of oxyradical and cytokines.