还原型谷胱甘肽预处理对单肺通气患者围手术期炎性因子和自由基的影响

Effect of reduced glutathione pretreatment on inflammatory factors and oxygen free radical during one-lung ventilation

目的探讨还原型谷胱甘肽（GSH）预处理对单肺通气患者围手术期炎性因子和自由基的影响。方法选择30例择期行肺叶切除术的肺癌患者，按随机数字表法分为GSH组和对照组，每组15例。GSH组于麻醉诱导后单肺通气前静脉输注GSH30mg／kg，对照组静脉输注等量0．9％氯化钠。于麻醉诱导前（T0）、单肺通气30min（T1）、单肺通气60min（T2）、恢复双肺通气60min（L）和术后2h（T4）采集桡动脉血，测定血浆肿瘤坏死因子（TNF）-α、白细胞介素（IL）-8、丙二醛（MDA）水平和超氧化物歧化酶（SOD）活性。结果T2～T4时两组MDA较T0时显著升高（P〈0．05）[GSH组T0～T4分别为（3．5±0．6）、（3．8±0．8）、（4．7±1．1）、（6．1±1．2）、（6．4±0．9）mol／L；对照组T0—T4分别为（3．7±0．5）、（4．1±0．6）、（5．9±1．2）、（7．4±1．0）、（7．8±1．1）mol／L]，但GSH组显著低于对照组（P〈0．05）。T2-T4时对照组SOD活性较T0时降低（P〈0．05），且低于GSH组（P〈0．05）。T1-T4时两组TNF-α、IL-8较T0时显著升高（P〈0．05），但GSH组T2～T4时TNF-α及T1～T4时Ib8显著低于对照组（P〈0．05）。结论GSH30mg／kg预处理可减轻单肺通气患者肺的炎性反应及脂质过氧化程度。

Objective To investigate the effect of reduced glutathione （GSH） pretreatment on inflammatory factors and oxygen free radical in patients during one-lung ventilation （OLV）. Methods Thirty patients with lung cancer undergoing lung resection were divided into GSH group （15 cases） and control group （ 15 cases） by random digits table. In GSH group,GSH 30 mg/kg in normal saline 100 ml was infused after induction of anesthesia before OLV,while in control group equal volume of normal saline was infused instead of GSH. Blood samples were collected before induction of anesthesia （T0） and at 30 min（T1 ）, 60 min （T2） of OLV and 60 min of two-lung ventilation （T3） and at 2 h after operation（T4） for determination of serum tumor necrosis factor （TNF） - α, interleukin （IL） -8 and malonaldehyde （ MDA ） concentrations and superoxide dismutase（SOD） activity. Results The serum MDA concentrations at T2-T4 were higher than those at To in two groups （P〈 0.05） [GSH group： （3.5 ± 0.6）, （3.8± 0.8）, （4.7 ± 1.1 ）, （6.1± 1.2）, （6.4 ± 0.9） mol/L at T0-T4;eontrol group： （3.7 ±0.5）, （4.1 ±0.6）, （5.9 ±1.2）, （7.4±1.0）, （7.8 ±1.1） mol/L at T0-T4],but GSH group was lower than control group（P 〈 0.05 ）. The serum SOD activity at Tz-T4 was lower than that at To in control group （P 〈 0.05 ）, and lower than GSH group（P 〈 0.05 ）. The serum TNF- α, IL-8 concentrations at TI-T4 were higher those that at To in two groups（P 〈 0.05 ）, the serum TNF- α concentrations at T2-T4 and IL-8 concentrations at T1-T4 in GSH group were lower than those in control group （P 〈0.05）. Conclusion Pretreatment with GSH 30 mg/kg can decrease inflammatory response and lipid peroxidation during OLV.