肺结核患者全身麻醉下手术中肺损伤的预处理效果观察

Effects of Pretreatment for Lung Injury to Tuberculosis Patients under General Anesthesia

目的观察麻醉时对肺结核患者手术中肺损伤进行预处理的疗效。方法选取肺结核行肺部手术患者100例,随机分A组和B组,各50例。B组麻醉前静脉注射还原型谷胱甘肽1.2 g、甲泼尼龙80 mg,切皮前将乌司他丁10万U加入100 m L 0.9%氯化钠注射液中,持续静脉输注1 h,每4 h各重复用药1次至患者出麻醉恢复室回病房;A组不用药。分别于手术切皮前(T1)、术中单肺通气结束时(T2)、回病房前(T3)抽取患者动脉血进行血气分析并计算氧合指数;抽取外周静脉血查血常规,采用酶联免疫吸附试验(ELISA)法检测白细胞介素-1(IL-1)、IL-6、IL-8和肿瘤坏死因子-α(TNF-α)等常见的促炎性细胞因子。结果 B组的动脉血氧分压(Pa O2)及血氧饱和度(Sp O2)、氧合指数明显高于A组(P<0.05);B组血液中白细胞计数和促炎性细胞因子水平明显低于A组(P<0.05)。结论麻醉时对肺结核患者肺部手术中肺损伤进行预处理,可减轻患者肺损伤程度,改善肺功能。

Objective To evaluate the effects of pretreatment for lung injury to tuberculosis patients under general anesthesia. Methods One hundred patients with tuberculosis undergoing operation were randomly divided into two groups with 50 each. Group B received in-travenous injection of reduced glutathione（1. 2 g） and methylprednisolone（80 mg） before anesthesia and intravenous infusion of ulinas-tatin 10 ＆#215; 104 U in 100 mL normal saline（0. 9% NaCL） for one hour before skin incision and every 4 hours thereafter until the pa-tients were sent back to wards. Arterial blood samples were taken before skin incision（T1）, at the end of one lung ventilation（T2 ） and before the return to wards（T3 ） for gas analysis and measurement of oxygen index; peripheral venous blood samples were taken for rou-tine examination and measurements of interleukin - 1（IL - 1）, IL - 6, IL - 8 and tumor necrosis factor alpha（TNF - α）by ELISA. Results PaO2, SpO2 and oxygen index in group B were significantly higher than those in group A（ P〈 0. 05）; numeration of white blood cells and pro inflammatory cytokines in group B were significantly lower than those in group A（ P〈 0. 05）. Conclusion Pretreatment for lung injury to tuberculosis patients can effectively alleviate the degree of injury, improve lung function, reduce postoperative complica-tions, shorten anesthesia recovery period and lower expenses.