盐酸戊乙奎醚预处理对胸腔镜下肺叶切除术老年患者非通气侧肺损伤的影响

Effect of penehyclidine hydrochloride pretreatment on non-ventilated lung injury in elderly patients with video-assisted-thoracoscopic pulmonary lobectomy

目的探讨盐酸戊乙奎醚预处理对胸腔镜下肺叶切除术老年患者非通气侧肺损伤的影响。方法选取2015年1月至2016年5月于辽宁中医药大学附属医院择期拟行胸腔镜下肺叶切除术的老年患者共120例，采用随机数字表法分为观察组和对照组，每组60例。观察组于麻醉诱导前10min静脉注射盐酸戊乙奎醚0．05mg／kg，对照组于麻醉诱导前10min静脉注射等容量0．9％氯化钠注射液。分别于药物干预前（T0）、单肺通气即刻（T1）、单肺通气60min时（T2）、单肺通气结束即刻（T3）、手术结束时（T4）和术后24h时（T5）抽取静脉血，检测血清肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）和IL-8水平。分别于T1、T3时切取拟切除肺叶周边的正常肺组织，评价肺泡损伤定量评价指标（IQA）和细胞凋亡指数（AI）；检测肺组织CCAAT／增强子结合蛋白同源蛋白（CHOP）的mRNA及蛋白表达。记录术后72h内肺部并发症的发生情况。结果观察组T2-T5时点血清TNF-α、IL-6和IL-8水平均明显低于对照组（P〈0．05）。观察组T1时点的IQA和AI均明显低于对照组[（15．8±3．8）％比（23．7±2．5）％，（14．8±2．7）％比（25．8±3．7）％]（P〈0．05）。观察组T1时点的肺组织CHOPmRNA及蛋白表达水平均明显低于对照组[（0．72±0．15）比（0．89±0．22），（0．69±0．20）比（0．97±0．29）]（P〈0．05）。对照组术后72h内肺部并发症的总发生率为46．7％（28／60），观察组为16．7％（10／60），组间比较差异有统计学意义（P〈0．05）。结论盐酸戊乙奎醚预处理可减轻胸腔镜下肺叶切除术老年患者非通气侧的肺损伤，其机制可能与减轻炎性反应、抑制CHOP介导的肺组织细胞凋亡有关。

Objective To explore the effect of penehyclidine hydrochloride （PHC） pretreatment on the damages of non-ventilated lung of video-assisted-thoracoscopic pulmonary lobectomy in elderly patients. Methods Totally 120 elderly patients who had thoracoscopic pulmonary lobectomy from January 2015 to May 2016 in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were randomly divided into observation group and control group, with 60 cases in each group. The observation group was intravenously injected PHC 0. 05 mg/kg and the control was injected equal volume of 0. 90/0 sodium chloride solution 10 min before anesthesia induction. Venous blood was took for detection of tumor necrosis factor-α （TNF-α） , interleukin-6 and -8 （ IL-6, IL-8 ） before drug intervention （ T0 ）, immediately when one-lung ventilation started （ T1 ）, 60 minafterone-lung ventilation（ T2 ）, immediately when one-lung ventilation was ended（T3） , immediately when the operation was ended（T4 ）and at 24 h after operation（T5 ）, respectively. Normal lung tissue surrounding resected lung lobe was excised at T1 and T3 ; the Index of Quantitative Evaluation for Alveolar Damage （IQA） and Apoptosis Index （AI） were calculated; CCAAT/enhancer-binding protein homologous protein （CHOP） mRNA and protein expression were detected. The incidence of postoperative pulmonary complications was recorded within 72 h after operation. Results Levels of TNF-α, IL-6 and IL-8 in observation group were significantly lower than those in control group from T2 to T5 （P 〈 0. 05 ）. IQA, AI CHOP mRNA and protein expression in observation group were significantly lower than those in control group at T3 [ （ 15.8 ± 3.8 ） % vs （23.7 ± 2. 5 ） %, （ 14.8 ± 2.7 ） % vs （25.8±3.7）%,（0.72±0.15） vs （0.89 ±0.22）,（0.69 ±0.20） vs （0.97 ±0.29）]（P〈0.05）. Pulmonary complication incidences within 72 h after operation in observation group were significantly lower than those in control group [ 16. 7% （ 10/60 ） vs 46. 7% （ 28/60 ） ] （ P 〈 0. 05 ）. Conclusion PCH can alleviate damages to non-ventilated lung in elderly patients with video-assisted-thoracoscopic lobectomy; the mechanism may be related to the effects on alleviating inflammation and inhibiting pneumonocyte apoptosis induced by CHOP.