乌司他丁对新辅助化疗肺癌患者炎症因子及呼吸功能的影响

Effects of ulinastatin on inflammatory factors and pulmonary function in perioperative period of lung resection in patients with lung cancer received neoadjuvant chemotherapy

目的研究在新辅助化疗肺癌患者实施肺叶切除术麻醉诱导后加用乌司他丁对其围术期炎症反应及呼吸功能的影响。方法拟行肺癌根治术的新辅助化疗肺癌患者60例,随机分为乌司他丁组(U组)和对照组(C组),每组30例。所有患者实施肺癌根治术均采用静吸复合全麻,麻醉诱导和术中麻醉维持用药相同,U组麻醉诱导后即静脉泵注乌司他丁10 000 U/kg,C组给予等量生理盐水。两组患者分别在麻醉诱导后(T1)、开胸后2 h(T2)、术毕(T3)、术后2 h(T4)及术后24 h(T5)采取静脉血,测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6和IL-8。检测术后24 h和48 h呼吸功能指标。结果两组患者TNF-α、IL-6和IL-8于T2明显上升(P<0.05,P<0.01),至T4达峰值(P均<0.01),于T5下降;组间相比,U组在T3、T4均明显低于C组(P<0.05,P<0.01)。术后24 h和48 h两组患者的FVC%、FEV1%及FEV1/FVC组间差异无统计学意义(P均>0.05)。术后24 h和48 h U组Pa O2明显高于C组(P<0.05),P(A-a)O2明显低于C组(P<0.05)。结论乌司他丁可在一定程度上抑制新辅助化疗后肺癌患者围术期炎症因子的释放,保护肺功能。

Objective To investigate the effects of ulinastatin use after anesthesia induction on inflammatory reactions and pulmonary function during perioperative period of lung resection in patients with lung cancer received neoadjuvant chemotherapy.Methods Sixty patients with lung cancer after neoadjuvant chemotherapy who were to receive radical operation for lung cancer were selected.The patients were randomly divided into 2 groups（n = 30 each） ：ulinastatin group（group U） and control group（group C）.In two groups,the intravenous and inhalational compound general anesthesia was all applied,and the drugs of anesthesia induction and intraoperative maintaining were same.After anesthesia induction,ulinastatin（10 000 U / kg） was given by intravenous pump injection in group U,and normal saline was given by intravenous infusion in group C.The venous blood samples were collected after anesthesia induction（T1）,2 h after thoracotomy（T2）,immediately postoperation（T3）,2 h after operation（T4） and 24 h after operation（T5） for determination of serum tumor necrosis factor（TNF）-α,interleukin（IL）-6 and IL-8.Pulmonary functions were measured24 h and 48 h after operation.Results In both groups,serum TNF-α,IL-6 and IL-8 levels at T2 were all significantly increased（P 〈 0.05 or P 〈 0.01） and reached the peak at T4（all P 〈 0.01）,then decreased at T5.Serum TNF-α,IL-6 and IL-8 levels at T3 and T4in group U were significantly lower than those in group C（P 〈 0.05 or P 〈 0.01）.There were no significant difference in FVC%,FEV1% and FEV1/ FVC at 24 and 48 hours after operation between two groups（all P 〉0.05）.At 24 and 48 hours after operation,Pa O2 in group U was significantly higher than that in group C（P 〈 0.05）,and P（A-a）O2in group U was significantly lower than that in group C（P 〈 0.05）.Conclusions Ulinastatin could inhibit the release of inflammatory factors to some extent in perioperative period of lung resection in patients with lung cancer received neoadjuvant chemotherapy and protect pulmonary functions.