乌司他丁预先给药对单肺通气患者肺损伤的影响

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

目的评价乌司他丁预先给药对单肺通气患者肺损伤的影响。方法择期行食道下段癌切除术患者60例,随机分为对照组(C组)和乌司他丁组(U组),每组30人。U组按5000 U.kg-1计算乌司他丁用量,半量于入室后缓慢静脉注射,半量持续1 h静脉点滴。C组以等量生理盐水代替。于麻醉诱导前(T1),单肺通气即刻(T2),单肺通气30 min(T3),双肺通气30 min(T4),术毕(T5)取血样,检测血清白细胞介素6(IL-6),肿瘤坏死因子α(TNF-α),肺表面活性蛋白A(SP-A),血清丙二醛(MDA)和8-异前列腺素(8-iso-PGF2a)的浓度。结果与T1时比较,T3,T4,T5时2组血清IL-6,TNF-α水平都升高(P<0.05或P<0.01),而U组升高幅度小,2组比较差异有统计学意义(P<0.05);C组血清SP-A,MDA,8-iso-PGF2a水平升高(P<0.05),U组差异无统计学意义;U组较C组T3,T4,T5时血清IL-6,SP-A,MDA,8-iso-PGF2a升高水平低,差异有统计学意义(P<0.05)。结论乌司他丁预先给药可减轻单肺通气造成的肺损伤。

Objective To investigate the effect of ulinastatin pretreatment on lung injury caused by one-lung ventilation.Methods Sixty patients scheduled for resection of carcinoma at the lower part of esophagus,were randomly assigned to 2 groups（n=30）：group C=control group;group U=ulinastain group.Each patient in group U received the total dose of 5000 U·kg-1 ulinastain.Half of the dose diluted in normal saline to 50 mL was injected into vein slowly while the venous was cannulated for fluid replacement after the patients entered the operation room.The residual half dose was solved in normal saline and administered by intravenous drip in 1h.The patients in group C received normal saline at the same volume with in group U.Blood samples were taken from internal jugular vein at the following time points：before induction of anesthesia（T1）,immediately into one-lung ventilation（T2）,30 min into one-lung ventilation（T3）,30 min after two-lung ventilation（T4）,the end of operation（T5）.The serum concentrations of interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）,alveolar surfactant protein A（SP-A）,malondialdehyde（MDA） and 8-iso-prostaglandin（8-iso-PGF2a） were measured.Results For each group serum concentrations of IL-6 and TNF-α increased at T3,T4,T5 compared with at T1（P〈0.05 or P〈0.01）;and the extents of increase were lower in group U than those in group C,the differences were statistically significant （P〈0.05）;serum concentrations of SP-A,MDA,8-iso-PGF2a increased at T3,T4,T5 compared with at T1（P〈0.05） in group C,but no significant increases were found in group U（P〉0.05）,compare the two groups,the serum concentrations of IL-6,SP-A,MDA,8-iso-PGF2a at T3,T4,T5 were lower in group U than those in group C.Conclusion Ulinastatin pretreatment could reduce lung injury caused by the one-lung ventilation.