沐舒坦在老年肺癌患者放射性粒子植入术中肺的保护作用

Pulmonary protective effect of mucosolvan treatment in elderly lung cancer patients undergoing radioactive seed implantation

目的观察老年肺癌患者行放射性粒子植入术后分别应用大剂量与小剂量沐舒坦治疗的肺保护效果。方法选取2012年3月至2013年3月在天津医科大学第二医院胸外科行CT引导下肺癌放射性粒子植入治疗的93例非小细胞肺癌患者，随机分成大剂量组、小剂量组以及对照组，每组31例，三组患者在术后行常规免疫以及营养支持等综合治疗的基础上大剂量组给予沐舒坦990mg／d持续静脉泵入，小剂量组给予300mg／d持续静脉泵入，对照组给生理盐水，比较三组患者术中气胸发生率和术后第l、3、5天的C反应蛋白（CRP）、肿瘤坏死因子a（TNF_a）、中性粒细胞绝对值（ANC）的水平差异。结果三组患者CRP、TNF—a以及ANC水平在术后第1、3天差异无统计学意义（P〉0．05），大剂量组患者CRP、TNF—a以及ANC在术后第5天均低于小剂量组和对照组（F=3．596、3．555、3．406，P=0．031、0．033、0．037），大剂量组气胸发生率低于对照组（x2=4．31，P〈0．05）。结论老年肺癌放射性粒子植入术围术期应用大剂量沐舒坦治疗有助于较快减轻肺部的炎性反应，减少气胸发生率。

Objective To observe the pulmonary protective effect of large and small doses of mucosolvan in elderly patients with lung cancer undergoing radioactive seed implantation. Methods 93 patients with non-small cell lung cancer undergoing radioactive seed implantation guided by CT were selected and randomly divided into 3 groups： the high-dose group, the low-dose group and control group （n = 31, each）. All patients received the mucosolvan treatment with routine immunization and nutrition support after implantation. Patients was given mueosolvan 990 mg/d and 300 mg/d by continuous intravenous pumping in high-dose and small-dose groups respectively. Patients in the control group was given saline. The incidence of pneumothorax and plasma levels of C reactive protein （CRP）, tumor necrosis factor alpha （TNF alpha）, neutrophils （ANC） were compared between the three groups at 1 d, 3 d and 5 d after implantation. Results There was no statistically significant difference in plasm levels of CRP, TNF alpha and ANC between the three groups at 1 d and 3 d after implantation （all P〈0.05）. Plasma levels of CRP, TNF alpha and ANC were lower in high-dose group than in low-dose group and control group at 5 d after implantation （F= 3. 596, 3. 555, 3. 406, respectively, all P（0.05）. The incidence of pneumothorax was lower in high-dose group than in control group （Xz ： 4.31, P （0.05） . Conclusions Perioperative application of high-dose mucosolvan can relieve lung inflammatory reaction rapidly and reduce the incidence of pneumothorax in elderly lung cancer patients undergoing radioactive seed implantation.