甲基强的松龙对单肺通气麻醉所致炎性肺损伤的保护作用

Protective effect of methylprednisolone on lung injury caused by one-lung ventilation

目的探讨甲基强的松龙(简称甲强龙)对单肺通气麻醉所致炎性肺损伤的保护作用。方法选取单肺通气麻醉下行食道癌根治手术的患者60例,随机等分为对照组和处理组,对照组滴注生理盐水,处理组滴注甲强龙,二组预处理后行单肺通气麻醉。分别于单肺通气前、单肺通气后30、60、120 min、单肺通气结束后60 min,测定细胞因子TNF-α、IL-1β、IL-6、IL-8、IL-10水平,监测患者血气指标变化情况。结果与单肺通气前相比,单肺通气后各监测时间点氧合指数明显降低,促炎因子TNF-α、IL-1β、IL-6、IL-8的水平及炎症抑制因子IL-10的含量随通气时间的延长均出现显著变化(P<0.05)。与对照组相比,甲强龙处理组单肺通气各监测时间点的氧合指数升高,促炎因子TNF-α、IL-1β、IL-6、IL-8的水平均显著降低,而炎症抑制因子IL-10水平显著增加(P<0.05)。结论甲强龙对单肺通气麻醉所致炎性肺损伤具有保护作用,其机制可能与促炎因子TNF-α、IL-1β、IL-6、IL-8表达的下调及炎症抑制因子IL-10水平的升高有关。

Objective To analyze the protective effect of methylprednisolone on lung injury caused by one-lung ventilation. Methods A total of 60 patients underwent esophageal cancer radical surgery with one-lung ventilation were selected. Patients were randomly divided into control group and treatment group. After dripping with saline in control group and methylprednisolone in treatment group, patients were conducted with one-lung ventilation （OLV）. At prior to OLV, 30, 60, 120 rain in OLV and 60 rain after OLV, the levels of TNF-α, IL-1β, IL-6, IL-8, IL-10 were detected, and the changes of blood gas index were analyzed. Results Compared with the prior to OLV, the oxygenation index decreased, the levels of proinflammatory factors TNF-α, IL-1β, IL-6, IL-8 significantly increased with the extension of aeration time, while the level of inflammation inhibiting factor IL-10 was down-regulated at each monitoring point of OLV （P 〈 0.05）. Compared with the controls, the oxygenation index increased, the levels of TNF-α, IL-1 β, IL-6, IL-8 significantly decreased and the IL-10 level was up-regulated at each monitoring point of OLV in patients treated by methylpred- nisolone （P 〈 0. 05）. Conclusion Methylprednisolone plays an protective effect on the lung injury caused by one-lung ventilation, and the mechanism might be associated with the decrease of proinflammatory factors TNF-α, IL-1β, IL-6, IL-8 as well as the increase of inflammation inhibiting factor IL-IO.