乌司他丁对食管癌根治术中肺损伤的保护作用

Protective effect of Ulinastatin on radical surgery for esophageal cancer on the lung injury

目的探讨乌司他丁在全麻食管癌根治术单肺通气(OLV)中的肺保护作用及其机制。方法全麻OLV下食管癌根治术患者40例,随机分为乌司他丁组(A组)和对照组(B组),每组20例。A组OLV开始后,静脉泵注乌司他丁10 000IU/kg,1h内注完;B组给予等量生理盐水。两组分别在麻醉诱导后(T0)、OLV后1h(T1)、OLV后2h(T2)、术后2h(T3)及术后24h(T4)5个时点采集动脉血,检测HMGB1、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)浓度。结果两组T0时点的HMGB1、TNF-α、IL-6、IL-8、IL-10的血清浓度无明显差异(P>0.05);两组病人T1、T2、T3、T4时点与T0比较HMGB1、TNF-α、IL-6、IL-8、IL-10血清浓度显著升高,差异具有统计学意义(P<0.05);与B组相比,A组T1、T2、T3、T4时点HMGB1、TNF-α、IL-8水平显著降低(P<0.05),IL-10水平明显升高(P<0.05)。结论乌司他丁显著增加食管癌根治术OLV患者血清IL-10的浓度,抑制HMGB1、TNF-α、IL-6、IL-8浓度的升高,在食管癌根治术OLV过程中起肺保护作用。

Abstract： Objective To explore the lung protective effect of ulinastatin （UTI） on esophagus cancer resec tion during one lung ventilation. Methods Fourty esophagus cancer resection patients were divided into two groups randomly. Ulinastatin group A （n =20）. ulinastatin 10 000 U/kg intravenous infusion contin ually during esophagus cancer resection in one hou;and the patients control group B （n =20）： the same volume of normal saline as in group A instead of ulinastatin. Blood concentrations of HMGB1.TNF-α, IL 6, 1L-8, 11710 were tested at post-induction of anesthesia （T0） ; one hour after one-lung ventilation （T1） two hours after one-lung ventilation （T2）; two hours after operation （T3）; 24 hours after operation （T4）. Results There were no marked differences in HMGB1, TNF-a, IL-6, 1178 and IL-10 levels at T,, in both groups （P 〉0.05）. Compared with T0, T , T2, Ta, T4 there are significant decrease in HMGB1,TNF a, IL-6, IL-8, IL 10 （P%0.05）in both groups. Compared with group B, HMGB1.TNF-a.II. 6 and 1I.-8 lev els were lower at T1 , T2, T：3, T/（P -〈0.05） in the group A, but the level of IL-10 was higher （P 〈 0.05）. Conclusion Ulinastatin significantly increased in patients with esophageal cancer resection （）LVserum IL-10 concentrations, inhibition of HMGB1, TNF-a, IL-6, IL-8 concentration, and radical surgery in esophageal cancer from the lung protection during OLV the role.