乌司他丁在食道癌根治术中肺保护作用的研究

The study on the lung protective effect of ulinastatin on radical surgery for esophageal cancer

目的探讨乌司他丁对食道癌根治术所致肺损伤的保护作用。方法 40例限期行食道癌根治术患者,随机分为乌司他丁组(U组,n=20)和对照组(C组,n=20)。于手术开始前U组按1万U/kg静脉给予乌司他丁,C组给予等容量的生理盐水。于单肺通气开始时(T0)、单肺通气1h(T1)、双肺通气15min(T2)、术后24h(T3)各监测时间点抽取静脉血5ml,并于T0、T1、T2时间点收集支气管肺泡灌洗液(BALF)3ml。用酶联免疫吸附法(ELISA)法测定血浆中TNF-α、IL-6、IL-8、IL-10及BALF中IL-8的浓度。结果血浆中,两组患者T1、T2、T3时点的TNF-α、IL-6、IL-10及T2、T3时点的IL-8浓度均较T0明显升高(P<0.05);乌司他丁组TNF-α、IL-6、IL-8增高幅度较C组小,而IL-10增高幅度大于C组,差异均T1有统计学意义(P<0.05)。BALF中,C组T1、T2时间点、U组T2时间点IL-8浓度较T0均升高(P<0.05)。U组患者在T1、T2时间点IL-8浓度较C组明显降低(P<0.05)。结论乌司他丁可抑制血浆中TNF-α、IL-6、IL-8及BALF中IL-8浓度,并增加血浆中IL-10的浓度,从而减轻食道癌根治术引发的肺损伤。

Objective To explore the protective effect of ulinastatin on radical surgery for esophageal cancer on the lung injury.Methods Forty esophagus cancer resection patients were randomly divided into two groups.Ulinastatin group U（n=20）：ulinastatin 10 000 U/kg intravenous infusion continually before the operation;and the patients control group C（n=20）：the same volume of normal saline.Beginning of one-lung ventilation（T0）,1h after one-lung ventilation（T1）,15 min after recovery of two-lung ventilation（T2）,and 24h after operation（T3）,the venous blood sample was taken from the internal jugular vein and the plasma was separated and stored at-70℃ for later analysis of TNF-α、IL-6、IL-8 and IL-10 with enzyme-linked immunosorbent assay（ELISA）.The bronchoalveolar lavage fluid（BALF） were also collected at T0、T1、T2 for IL-8 detection.Results The levels of TNF-α,IL-6,IL-10 in the plasma were collected at T1、T2、T3 and IL-8 levels collected at T2、T3 increased significantly as compared with those in samples collected at T0.TNF-α、IL-6、IL-8 levels in the group U were significantly lower than those in the group C;IL-10 levels in the group U were significantly higher than those in the group C.In BALF,IL-8 levels in the group C collected at T1、T2 and that in the group U collected at T2 increased significantly as compared with those in samples collected at T0;IL-8 levels in the group U were significantly lower than those in the group C.Conclusion Ulinastatin can inhibit the TNF-α,IL-6,IL-8 levels and increase IL-10 levels and reduce the lung injury from radical surgery for esophageal cancer.