依达拉奉预先给药对单肺通气患者肺损伤的影响

Effects of edaravone pretreatment on the lung injury during one-lung ventilation

目的 探讨依达拉奉预先给药对单肺通气患者肺损伤的影响.方法 择期行食管下段癌切除术患者40例,男性,ASA分级Ⅰ或Ⅱ级,年龄48～64岁,体重指数18～26 kg/m2,随机分为2组（n=20）：对照组（C组）和依达拉奉组（E组）.E组于切皮时开始静脉输注依达拉奉0.5 mg/kg（溶于100 ml生理盐水）,经30 min输注完毕.术中记录PETCO2和气道压峰值（Ppeak）.于开胸前和术毕时取肘静脉血样,检测血清肺表面活性蛋白A（SP-A）、MDA、SOD和TNF-α的水平.结果 两组术中PETCO2、Ppeak比较差异无统计学意义（P＞0.05）.两组单肺通气后血清SOD活性降低,MDA、TNF-α、SP-A水平升高（P＜0.05）;与C组比较,E组血清SOD活性升高,MDA、TNF-α、SP-A水平降低（P＜0.05）.结论 依达拉奉预先给药可抑制氧化应激反应和炎性反应,减轻单肺通气患者的肺损伤.

Objective To investigate the effects of edaravone pretreatment on the lung injury during onelung ventilation （OLV） in patients.Methods Forty ASA Ⅰ or Ⅱ male patients, aged 48-64 yr, with body mass index 18-26 kg/m2, undergoing elective resection of esophageal carcinoma, were randomly divided into 2 groups （n = 20 each）： control group （group C） and edaravone group （group E）. Anesthesia was induced with fentanyl,propofol and rocuronium and maintained with sevoflourane, remifentanil and atracurium. The patients were mechanically ventilated （during OLV VT 8 ml/kg, RR 15 bpm, I：E 1：1.5）. In group E edaravone 0.5 mg/kg （in normal saline 100 ml） was infused over 30 min after skin incision. PETCO2 and peak airway pressure （Ppeak） were recorded during operation. Venous blood samples were obtained before opening the thoracic cavity and at the end of operation for determination of serum SOD activity and the levels of serum surfactant protein A （SP-A）, MDA and TNF-α. Results There was no significant difference in PETCO2 and Ppeak during operation between the two groups （P 〉 0.05）. Serum SOD activity was significantly decreased, while the levels of serum SP-A, MDA and TNF-α were significantly increased after OLV in both groups （P 〈 0.05）. Serum SOD activity was significantly higher,while the levels of serum SP-A, MDA and TNF-α were significantly lower at the end of operation in group E than in group C （P 〈 0.05）. Conclusion Edaravone pretreatment can reduce the lung injury during OLV through inhibiting oxidative response and inflammatory response in patients.