糖皮质激素雾化吸入对食管癌术后患者肝肺功能及免疫功能的影响

Effect of glucocorticoid aerosol inhalation on liver and lung function and immune function in patients with esophageal cancer after operation

目的探讨糖皮质激素雾化吸入对食管癌术后患者肝肺功能的保护作用及免疫调节作用。方法选取2012年2月至2015年8月于我院接受手术治疗的84例食管癌患者,按随机数字表法分为对照组与观察组,每组42例,两组患者术后均采用雾化吸入处理,对照组应用氨溴索雾化吸入,观察组在此基础上加用布地奈德干预,比较两组患者雾化治疗前后的血氧饱和度(SaO_2)、血氧分压(PaO_2)、氧合指数(OI)等肺功能指标的变化,测定患者谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBil)等肝功能指标及CD3^+、CD4^+、CD8^+免疫指标的变化,观察患者炎症指标C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)的改善情况,统计术后并发症发生率。结果术后6 d,观察组患者的PaO_2、OI均高于对照组[(98.41±2.33)mm Hg、(590.33±41.02)mm Hg vs(86.21±1.48)mm Hg、(521.16±50.33)mm Hg];术后6 d,观察组患者的ALT、AST、TBil均低于对照组[(21.22±1.26)U/L、(20.61±2.36)U/L、(10.81±2.98)μmol/L vs(26.04±3.11)U/L、(25.92±3.15)U/L、(15.11±3.31)μmol/L];术后6 d,观察组患者的CD3^+、CD4^+均高于对照组[(60.11±3.22)%、(32.41±2.61)%vs(55.12±2.12)%、(29.24±2.74)%];术后6 d,观察组患者的CRP、TNF-α均低于对照组[(6.41±1.23)mg/L、(6.22±1.02)ng/L vs(7.92±1.55)mg/L、(8.11±1.22)ng/L],以上各项指标比较差异均有统计学意义(P<0.05);术后观察组患者的并发症发生率为7.14%,明显低于对照组的28.57%,差异有统计学意义(P<0.05)。结论食管癌患者术后采用氨溴索联合糖皮质激素布地奈德雾化吸入治疗,可保护患者肝、肺功能,提升患者细胞免疫水平,降低术后并发症发生率。

Objective To explore the protective effect of glucocorticoid aerosol inhalation on liver and lung function and regulation effect on immune function in patients with esophageal cancer after operation. Methods Eighty-four patients with esophageal cancer who received operation in our hospital between February 2012 and August 2015 were divided into the control group and the observation group by the random number table method, with 42 cases in each group. Patients in both groups were treated by aerosol inhalation. The control group was treated by ambroxol aerosol inhalation. Based on this, the observation group was treated by budesonide intervention. The changes of blood oxygen saturation （SaO2）, partial pressure of blood oxygen （PaO2）, oxygenation index （OI） and other lung function indexes before and after aerosol inhalation were compared between the two groups. The aspartate aminotransferase （AST）, alanine aminotransfer- ase （ALT）, total bilirubin （TBIL） and other liver fimction indexes, CD3＋, CD4 ＋, CD8± and other immune indexes were de- termined. The improvement of C-reactive protein （CRP） and tumor necrosis factor alpha （TNF-α） was observed, and the incidence of postoperative complications was statistically analyzed. Results Six days after operation, PaO2 and OI of patients in the observation group were respectively （98.41±2.33） mmHg, （590.33±41.02） mmHg, which were higher than （86.21±1.48） mmHg, （521.16±50.33） mmHg of the control group. Six days after operation, the levels of ALT, AST and TBIL in patients in the observation group were （21.22±1.26） U/L, （20.61±2.36） U/L, （10.81±2.98） μmol/L, respectively, which were lower than （26.04±3.11） U/L, （25.92±3.15） U/L, （15.11±3.31） ±tmol/L in the control group. Six days after operation, CD3＋ and CD4＋ in observation group were （60.11 ±3.22）%, （32.41 ±2.61）%, respectively, which were higher than （55.12±2.12）%, （29.24±2.74）% in the control group. Six days after operation, CRP and TNF-α in the observation group were （6.41 ± 1.23） mg/L, （6.22±1.02） ng/L, respectively, which were lower than （7.92± 1.55） mg/L, （8.11 ± 1.22） ng/L in the control group. All of these differences above were statistically significant （P〈0.05）. The incidence of postoperative complications in patients in the observation group was 7.14%, which was lower than 28.57% in the control group （P〈 0.05）. Conclusion The application of ambroxol combined with glucocorticoid budesonide aerosol inhalation in patients with esophageal cancer after operation can protect liver and lung function, improve the level of cellular immune and reduce the incidence of postoperative complications.