盐酸戊乙奎醚对单肺通气患儿非通气侧肺损伤的影响

Effect of penehyclidine hydrochloride on damage to non-ventilated lung in pediatric patients undergoing one-lung ventilation

目的评价盐酸戊乙奎醚对单肺通气患儿非通气侧肺损伤的影响。方法择期拟行胸腔镜下肺叶切除术患儿120例，性别不限，年龄2—6岁，体重指数17～24kg／m2，ASA分级I或Ⅱ级，NYHA心功能分级I或Ⅱ级。采用随机数字表法将患儿分为2组（n=60）：对照组（C组）和盐酸戊乙奎醚组（P组）。于麻醉诱导前10min时P组静脉注射盐酸戊乙奎醚0．05mg／kg，C组静脉注射等容量生理盐水。分别于药物干预5min（T0）、单肺通气即刻（T1）、单肺通气60min（T2）、单肺通气结束即刻（T3）、术毕（T4）和术后24h（T5）时，采集静脉血样，采用ELISA法检测血清TNF-α、IL-6和IL-8的浓度。分别于T1和T3时切取拟切除肺叶周边正常肺组织，光镜下进行损伤肺泡计数，计算肺泡损伤率；电镜下观察上皮细胞超微结构；采用TUNEL法检测细胞凋亡情况，计算细胞凋亡指数。结果与T0时比较，2组T3时肺泡损伤率和细胞凋亡指数均升高，T2-5时血清TNF-α、IL-6和IL-8的浓度升高（P〈0．05），病理学损伤明显；与C组比较，P组T3时肺泡损伤率和细胞凋亡指数均降低，T2-5时血清TNF-α、IL-6和IL-8的浓度降低（P〈0．05），病理学损伤减轻。结论盐酸戊乙奎醚可减轻单肺通气患儿非通气侧肺损伤，其机制可能与抑制全身炎症反应和肺组织细胞凋亡有关。

Objective To evaluate the effect of penehyclidine hydrochloride on the damage to the non-ventilated lung in the pediatric patients undergoing one-lung ventilation （OLV）. Methods One hundred and twenty pediatric patients of both sexes, aged 2-6 yr, with body mass index of 17-24 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ and New York Heart Association class Ⅰ or Ⅱ , undergoing elective lobectomy performed via video-assisted thoracoscope, were randomly divided into 2 groups （n=60 each ） using a random number table： control group （group C ） and penehyclidine hydroehloride group （group P）. At 10 min before anesthesia induction, penehyclidine hydrochloride 0.05 mg/kg was injected intravenously in group P, and the equal volume of normal saline was given in group C. At 5 min after drug intervention （ TO ） , immediately after onset of OLV （ T1 ） , at 60 min of OLV （T2） , immediately after the end of OLV （ T3 ） , at the end of surgery （T4 ） , and at 24 h after surgery （T5） , venous blood samples were collected for determination of serum tumor necrosis factor-alpha （TNF- a）, interleukin-6 （IL-6） and IL-8 concentrations by enzyme-linked immunosorbent assay. The specimens of normal lung tissues around the lung lobe to be resected were obtained at T1 and T3 for determination of the injured alveolus count （with a light microscope） and cell apoptosis （using TUNEL） and for examination of the uhrastructure of epithelial cells （with a transmission electron microscope）. The injured alveolus rate （IAR） and apoptosis index （AI） were calculated. Results Compared to the value at To, the IAR and AI were significantly increased at T3 , the serum TNF-α, IL-6 and IL-8 concentrations were significantly increased at T2-5 （P〈0.05）, and the pathological changes were obvious in the two groups. Compared to group C, the IAR and AI were significantly decreased at T3, the serum TNF-α, IL-6 and IL-8 concentrations were significantly decreased at T2.5 （P〈0.05）, and the pathological changes were significantly reduced in group P. Conclusion Penehyclidine hydrochloride can attenuate the damage to the non-ventilated lung in the pediatric patients undergoing OLV, and the mechanism is probably related to inhibition of systemic inflammatory responses and cell apoptosis in lung tissues.