6％羟乙基淀粉130/0.4与聚明胶肽对肺癌切除术患者肺组织炎性反应的影响

Effects of 6% hydroxyethyl starch 130 /0. 4 and polygeline on the inflammatory response of lung in patients undergoing lung cancer resection

目的 比较6％羟乙基淀粉130/0.4与聚明胶肽对肺癌切除术患者肺组织炎性反应的影响.方法 择期行右肺上叶切除术患者20例,年龄45～74岁,ASAⅡ级.随机均分为6％羟乙基淀粉130/0.4组（A组）和聚明胶肽组（B组）.麻醉诱导后插入左侧双腔支气管导管,行机械通气.A、B组分别以0.67 ml·kg-1 ·min-1的速率静脉输注6％羟乙基淀粉130/0.4和聚明胶肽,输注量均为10 ml/kg.记录单肺通气时间、术中晶体量及胶体量.于麻醉诱导平稳后（T0）、单肺通气0.5 h（T1）、单肺通气1 h（T2）、双肺通气0.5 h（T3）时取桡动脉（肺静脉）血及中心静脉（肺动脉）血各3 ml,测定血清IL-6、IL-8、IL-10、SOD及MDA的浓度.桡动脉血加测表面活性物质结合蛋白A（SP-A）浓度.计算IL-6净释出量（IL-6n）、IL-8净释出量（IL-8n）、IL-10净释出量（IL-10n）、SOD净消耗量（SODn）和MDA净生成量（MDAn）.同时记录PaCO2、PaO2及Hct,并计算氧和指数（OI）及呼吸指数（RI）.结果 与T0时比较,T1～T3时两组IL-6n、IL-8n、IL-10n、SP-A、SODn及MDAn均明显升高,T1,T2时两组RI明显升高,OI明显降低（P＜0.05）.与A组比较,T1～T3时B组IL-6n、IL-8n、SP-A、SODn及MDAn明显升高（P＜0.05）,IL-l0n明显降低（P＜0.05）.结论 6％羟乙基淀粉130/0.4较聚明胶肽可更好地缓解右肺上叶切除术患者肺脏炎性反应及氧化应激反应,对OI及RI无明显影响.

Objective To compare the effects of 6% hydroxyethyl starch 130/0.4 and polygeline on the inflammatory response of lung in patients undergoing lung cancer resection.Methods Twenty patients undergoing lung cancer resection,ASA Ⅱ,aged 45-74 y,were equally randomized into two groups：6% hydroxyethyl starch 130/0.4 group （group A） and polygeline group （group B）.Mechanically ventilated was performed after anesthesia induction and intubation with leftsided double lumen endobronchial tube Internal jugular vein was cannulated for CVP monitoring.6 % hydroxyethyl starch 130/0.4 or polygeline 10 ml/kg was infused iv at a rate of 0.67 ml·kg-1 ·min-1.The time of one lung ventilation and the volume of crystalloid and colloid fluid were recorded.Blood samples were obtained from radial artery and internal jugular vein after intubation （T0）,0.5 h （T1） and 1 h （T2） after one lung ventilation,and 0.5 h after two lung ventilation （T3）.The levels of IL-6,IL-8,IL-10,SOD,MDA were determined in blood samples from artery and vein; and surfactant protein-A （SP-A） was determined in blood samples from artery.The net release levels of IL-6 （IL-6n）,IL-8 （IL-8n） and IL-10 （IL-10n）,the net consumption of SOD （SODn） and the net generation of MDA （MDAn） were calculated.PaCO2,PaO2 and Hct were recorded,and oxygenation index （OI） and respiratory index （RI） were calculated.Results Compared with T0.IL-6n,IL-8n,IL-10n,SODn and MDAn increased at T1-T3,and RI increased and OI decreased at T1,T2 in the two groups （P〈 0.05）.Compared with group A,IL-6n,IL-8n,SP-A,SODn and MDAn increased and IL-10n decreased at T1-T3 in group B （P〈0.05）.Conclusion Compared with polygeline,6% hydroxyethyl starch 130/0.4 can relieve the inflammatory response and oxidative stress in patients undergoing lung cancer resection,but there is no significant difference in RI and OI between the two groups.