帕瑞昔布钠对胸腔镜下肺叶切除术老年患者血清肺表面活性蛋白A和炎症反应的影响

Effect of parecoxib sodium on serum surfactant protein A and inflammatory response in elderly patients undergoing video-assisted thoracoscopic pneumonectomy

目的探讨应用不同剂量帕瑞昔布钠对胸腔镜下肺叶切除术老年患者血清肺表面活性蛋白A(surfactant protein A,SP-A)和炎症反应的影响。方法择期全麻下行胸腔镜下肺叶切除术老年患者62例,性别不限,年龄65~78岁,体重51~79kg,ASAⅠ或Ⅱ级,采用随机数字表法,随机分为三组:帕瑞昔布0.3mg/kg组(P1组,n=21)、帕瑞昔布0.6 mg/kg组(P2组,n=21)和对照组(C组,n=20)。P1、P2组患者在麻醉诱导前即刻和术后12h分别静脉推注帕瑞昔布钠0.3、0.6mg/kg,C组静脉推注同容量生理盐水。分别于麻醉诱导前即刻(T0)、手术结束(T1)、术后12h(T2)、术后24h(T3)采集中心静脉血,采用ELISA法测定血清SP-A、TNF-α、IL-6和IL-8浓度。记录术后72h肺部并发症的发生情况。结果与T0时比较,T1~T3时三组患者血清SP-A、TNF-α、IL-6、IL-8浓度明显升高(P<0.05);T_1~T_3时P1和P2组血清SP-A、TNF-α、IL-6、IL-8浓度明显低于C组(P<0.05)。三组患者术后72h肺部并发症发生率差异无统计学意义。结论胸腔镜下肺叶切除术老年患者围术期应用帕瑞昔布钠0.3mg/kg可明显抑制血清SP-A浓度升高,减轻炎症反应。

Objective To investigate the effects of perioperative parecoxib sodium on serum surfactant protein A and inflammatory response in elderly patients undergoing video-assisted thoracoscopic pneumonectomy.Methods Sixty-two ASA Ⅰor Ⅱ elderly patients,aged 65-78 years,weighing 51-79 kg,scheduled for elective video-assisted thoracoscopic pneumonectomy under general anesthesia,were randomly divided into 3 groups：0.3 mg/kg parecoxib sodium group（group P1,n=21）,0.6 mg/kg parecoxib sodium group（group P2,n=21）and control group（group C,n=20）.The patients were given intravenous parecoxib sodium of 0.3 mg/kg immediately before induction of anesthesia and at 12 hafter operation in group P1,and also parecoxib sodium of 0.6 mg/kg immediately before induction of anesthesia and at 12 hafter operation in group P2,while the equal volume of normal saline was given in group C.Blood samples were taken from the central vein before the induction of anesthesia（T_0）,after operation（T_1）,12 hafter operation（T_2）and 24 hafter operation（T_3）.The concentration of serum surfactant protein A（SP-A）,TNF-α,IL-6 and IL-8 were determined by ELISA.The incidence of pulmonary complications at 72 h after operation were also recorded.Results Compared with T_0,the concentration of serum SP-A,TNF-α,IL-6 and IL-8 increased significantly in all groups at T_1-T_3（P0.05）.Compared with C group,the concentration of serum SPA,TNF-α,IL-6 and IL-8 in groups P1 and P2 decreased significantly at T_1-T_3（P〈0.05）,there were no significant differences between groups P1 and P2.The incidence of postoperative pulmonary complications had no statistically significant differences between the three groups.Conclusion Parecoxib sodium can significantly reduce the concentration of serum SP-A and alleviate the inflammatory response in elderly patients undergoing video-assisted thoracoscopic pneumonectomy.