盐酸戊乙奎醚对单肺通气心脏瓣膜置换术患者非通气侧肺损伤的影响

Influences of penehyclidine hydrochloride on damage to non-ventilated lung in patients undergoing cardiac valve replacement with one-lung ventilation

目的分析盐酸戊乙奎醚对单肺通气心脏瓣膜置换术患者非通气侧肺损伤的影响。方法纳入2015年1月至2016年6月我院收治的行心脏瓣膜置换术患者116例,按随机数字表法将其分为2组,每组58例。观察组术前给予盐酸戊乙奎醚,对照组给予等量生理盐水。比较两组患者麻醉前、术毕即刻和术后24 h患者血清白介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)和超氧化物歧化酶(SOD)水平,比较非通气侧氧合指数和动态肺顺应性(Cdyn)变化。结果术毕即刻,两组患者血清IL-6、IL-8、TNF-α水平升高,SOD水平、氧合指数、Cdyn水平降低,与麻醉前比较,差异有统计学意义(P<0.05)。术后24 h,两组患者血清IL-6、IL-8、TNF-α水平降低,观察组SOD水平、氧合指数升高,对照组SOD水平、氧合指数、Cdyn升高,与麻醉前比较,差异均有统计学意义(P<0.05)。术毕即刻和术后24 h,两组IL-6、IL-8、TNF-α、SOD、氧合指数、Cdyn比较,差异均有统计学意义(P<0.05)。结论盐酸戊乙奎醚可调节患者体内炎症因子水平、改善氧合指数和肺顺应性,对单肺通气心脏瓣膜置换术患者非通气侧肺损伤具有保护作用。

Objective To analyze the influences of penehyclidine hydrochloride on damage to non-ventilated lung in patients undergoing cardiac valve replacement with one-lung ventilation. Methods Totally 116 patients with cardiac valve replacement in our hospital from January 2015 to June 2016 were randomly divided into observation group and control group ,58 patients in each group. Observation group received penehyclidine hydrochloride therapy, and control group received equal volume of saline therapy. IL-6, IL-8, TNF-α, SOD, changes of oxygenation index and Cdyn of the two groups were analyzed before anesthesia,immediately after surgery and at postoperative 24 h. Results Immedi- ately after surgery, the serum levels of IL-6, IL-8 and TNF-α in the two groups were increased, and SOD level, changes of oxygenation index and Cdyn were decreased than before anesthesia, the differences being statistically significant （ P 〈 0. 05 ）. At 24 h after operation, the serum levels of IL-6, IL-8 and TNF-α were decreased in the two groups, SOD level and changes of oxygenation index of observation group were increased, and the SOD level, changes of oxygenation index and Cdyn level of treatment group were increased, compared with before anesthesia, the differences being statisti- cally significant （ P 〈 0. 05 ）. Immediately and 24 h after surgery, the differences of IL-6, IL-8, TNF-α, SOD, changes of oxygenation index and Cdyn between the two groups were statistically significant （ P 〈 0. 05 ）. Conclusion Penehyclidine hydrochloride can adjust the inflammatory factor levels, oxygenation index and Cdyn, and it has a protective effect on non-ventilated lung in patients undergoing cardiac valve replacement with one-lung ventilation.