乌司他丁联合保护性肺通气模式在食管癌根治术中的应用

The effects of ulinastatin combined with protective lung ventilation in radical resection of esophageal cancer

目的探讨食管癌根治术患者行单肺通气(OLV)期间应用乌司他丁联合保护性肺通气模式对肺内分流及炎性因子的影响。方法将48例择期行肺切除手术的患者分为保护性通气组(P组)和乌司他丁联合保护性通气组(U组)各24例,分别记录OLV前(T0)、OLV后30min(T1)及60min(T2)、双侧通气后(T3)的气道峰压(Ppeak)和肺内分流(Qs/Qt)值,并测定各时点的血清IL-8、TNF-a水平。结果 (1)两组患者在术中各时点的Ppeak和Qs/Qt值变化趋势基本相同,而U组稍低于P组,但差异均无统计学意义(P>0.05)。(2)两组患者在术中的血清TNF-a和IL-8水平均明显高于OLV前,差异有统计学意义(P<0.05);而P组患者的血清TNF-a水平还明显高于U组患者,且P组患者在T2、T3时点的血清IL-8水平亦明显高于U组患者,差异均有统计学意义(P<0.05)。结论 OLV期间,乌司他丁联合保护性通气可以明显减轻炎症反应,有效减轻肺损伤。

Objective To investigate the effects of ulinastatin combined with protective lung ventilation on intrapulmonary shunt and inflammatory response during one lung ventilation（OLV）. Methods 48 patients of esophageal cancer undergoing radical surgery were randomly divided into two groups., protective ventilation group（P group）, ulinastatin combined with protective ventilation group（U group）, and 24 patients in each group. The peak pressure of airway（Ppeak）and pulmonary shunt value（Qs/Qt）were recorded and serum IL-8.TNF-a were tested at the time of before OLV（T0）,after OLV 30 min（T1）,60min（T2）and after two lung ventilation（T3）. Results The change trends of Ppeak and Qs/Qt in each time point in two groups were most of same,that in U group were slightly lower than in P group, but the differences were not statistically significant（P〈0.05）. The levels of TNF-a and IL-8 during operation were significantly higher than that at To, the differences were statistically significant（P〈0. 05）. The serum TNF-a in P group was significantly higher than that in U group,the level of IL-8 in P group at T2 ,T3were also higher than that in U group, the differences were all statistically significant （P 〈 0.05）. Conclusion Ulinastatin combined with protective lung ventilation can significantly reduce the inflammatory reaction, reduce lung injury during OLV.