乌司他丁联合多索茶碱对老年食管癌手术患者的肺保护作用

Protective Effect of Ulinastatin Combined with Doxofylline on Lung of Eldly Esophageal Cancer in Radical Surgery

目的探讨乌司他丁联合多索茶碱对老年食管癌手术患者围手术期的肺保护作用及其可能机制。方法择期食管癌根治患者80例,年龄65~80岁。随机均分为4组,各组药物均用生理盐水稀释静脉滴注,其中U组(乌司他丁10kU/kg)、D组(多索茶碱4mg/kg)、U+D组(乌司他丁联10kU/kg+多索茶碱4mg/kg)和C组(对照组)等剂量的生理盐水。在单肺通气(OLV)前(T0)、OLV后60min(T1)、双肺通气后(T2)及手术结束(T3)检测血清肿瘤坏死因子-α(TNF-α)、白介素-6和10(IL-6和IL-10)及丙二醛(MDA)的浓度,并检测上述各个时间点的血气。记录患者术中OLV时间、手术时间、失血量、补液量和尿量,观察术后患者低氧血症、肺部感染的发生情况。结果一般资料,各组比较差异无统计学意义(均P>0.05)。T1~T3时,与C组相比较,U组、D组和U+D组的TNF-α、IL-6和MDA浓度明显降低、IL-10明显增高、术后低氧血症和肺部感染发生率明显降低(均P<0.05),D组和U+D组的PaO_2明显增高(均P<0.05),而U组的PaO_2无明显升高(P>0.05)。与U+D组相比较,U组和D组的TNF-α、IL-6和MDA浓度高于U+D组,IL-10及PaO_2低于U+D组,术后低氧血症和肺部感染发生率也高于U+D组(均P<0.05)。结论乌司他丁联合多索茶碱可抑制老年食管癌手术患者OLV期间的炎症反应和氧化应激反应,降低术后低氧血症和肺部感染的发生率,对食管癌患者手术引发的肺损伤具有更好的保护作用。

Objective To investigate the effect and the possible mechanism of ulinastatin combined with doxofylline on lung injury of elderly esophageal cancer patients in perioperative period.Methods Eighty patients who accepted esophageal cancer radical operation under general anesthesia were randomly divided into four groups：the control group（group C）,the ulinastatin group（Group U）,the doxofylline group（Group D）and the ulinastatin＋doxofylline group（Group U＋D）,20 patients in each group.All the patients were 65 to 80 years old.Conventional intravenous anesthesia,right bronchial intubation with double channel catheter was applied for mechanical ventilation.After inserting intubation tube,10 kU/kg ulinastatin in Group U was diluted by normal saline and intravenous drip conducted.Doxofylline（4 mg/kg）in Group D was administered（intravenous drip）.10 kU/kg ulinastatin＋4 mg/kg doxofylline in Group U＋D were administered（intravenous drip）.Group C was administrated（intravenous drip）with equal normal saline.Before one-lung ventilation（OLV）（T_0）,after OLV for 60 min（T_1）,after two-lung ventilation（T_2）and at the end of operation（T_3）,radial artery blood was collected to detect concentration of serum TNF-α,IL-6,IL-10 and MDA.Moreover,blood gas of each time point was detected.OLV time,operation time,blood loss volume,fluid infusion and urine volume in operation were recorded.Hyoxemia and pulmonary infection after operation were observed.Results In general information,there was no statistical difference among these groups（P0.05）.By making a comparison on each index of patients in four groups at T0,there was no statistical difference（P0.05）.At T1-T3,as compared with group C,the concentration of TNF-α,IL-6 and MDA was significantly reduced,but the concentration of IL-10 was significantly increased,the incidence rates of hyoxemia and pulmonary infection were significantly reduced in group U,group D and group U＋D（all P0.05）.PaO_2 was significantly increased in group D and group U＋D（both P0.05）,but not signicantly increased in group U（P0.05）.At T1-T3,as compared with group U＋D,the concentration of TNF-α,IL-6 and MDA was higher,PaO_2 and the concentration of IL-10 were lower,the incidence rates of hyoxemia and pulmonary infection were higher in group U and group D（P0.05）. Conclusion Ulinastatin combined with doxofylline can restrain inflammatory response and oxidativestress in elderly esophageal cancer patients during the period of OLV,reduce incidence rates of hyoxemia and pulmonary infection after operation,and may play agood protective role in lung injury triggered by esophageal cancer.