乌司他丁对双肺通气腔镜肺大泡切除患者术后恢复的影响

Effect of Ulinastatin on Postoperative Recovery of Endoscopic Pulmonary Bullor Resection

目的观察乌司他丁对双肺通气腔镜肺大泡切除患者术后恢复的影响。方法择期全身麻醉双肺通气腔镜单侧肺大泡切除患者60例随机分为三组(n=20):A组(生理盐水组)、B组(甲泼尼龙组)、C组(乌司他丁组)。患者均给与生理盐水注射液100 ml静脉泵注(10 ml·min^(-1));甲泼尼龙组和乌司他丁组患者在生理盐水中分别加入甲泼尼龙40 mg、乌司他丁50万单位。记录患者术前(T0),关胸(T1),拔管(T2)时患者HR、MAP、P_aO_2、P_aCO_2变化以及术后苏醒时间、拔管时间、Steward苏醒评分。结果与T0比较,三组患者T1、T2时P_aO_2、P_aCO_2明显升高;与T1比较,三组患者T2时Pa_O_2、P_aCO-2显著降低(P<0.05)。与A组比较,B、C组患者苏醒时间、拔管时间缩短,Steward苏醒评分增加(P<0.05);与B组比较,C组患者苏醒时间、拔管时间缩短,Steward苏醒评分增加(P<0.05)。结论甲泼尼龙、乌司他丁可以明显改善单腔气管插管全身麻醉单孔胸腔镜单侧肺大泡切除患者术后恢复和氧合功能,具有肺保护作用;比较而言,乌司他丁不及甲泼尼龙的保护作用明显。

Objective To investigate the effects of ulinastatin on postoperative recovery of patients undergoing uniportal video-assisted thoracoscopic unilateral bullectomy under two-lung ventilation. Methods 60 patients（ ASA Ⅰ-Ⅱ） were randomly divided into three groups（ n = 20 each） ： Normal saline group（ Group A）,methylprednisolone group（ Group B） and ulinastatin group（ Group C）. All patients were given intravenous infusion of 100 ml saline injection（ 10 ml·min^（-1））; Patients in Group B and C were dissolved methylprednisolone 40 mg,ulinastatin 500 thousand units in saline individually. P_aO_2 and P_aCO_2 of all patients at the time of T0（ before operation）,T1（ Thoracic closure）,T2（ extubation）,and postoperative wake-up time,extubation time,Steward score were recorded. Results Compared with T0,P_aO_2 and P_aCO_2 of all patients at the time of T1,T2 were increased significantly; Compared with T1,P_aO_2 and P_aCO_2 of all patients at the time of T2 were significantly decreased（ P 〈0. 05）. Compared with Group A,Wake-up time and extubation time of patients in Group B and C were significantly decreased,while Steward score increased（ P 0. 05）; Compared with Group B,Wake-up time and extubation time of patients in Group C were significantly decreased,while Steward score increased（ P 0. 05）. Conclusion Ulinastatin and methylprednisolone can significantly improve the postoperative recovery and oxygenation function of patients undergoing uniportal video-assisted thoracoscopic unilateral bullectomy under two-lung ventilation individually; In comparison,the protective effect of ulinastatin was significantly less than methylprednisolone.