氟比洛芬酯对老年患者腹腔镜手术的肺保护作用

Lung Protection of Flurbiprofen Axetil in Elderly Patients Undergoing Laparoscopic Surgery

目的探讨氟比洛芬酯对老年患者腹腔镜手术的肺保护作用。方法选择在笔者医院接受腹腔镜胃癌根治手术的患者60例,年龄≥65岁,性别不限,BMI 18～29kg/m2,ASA分级Ⅰ或Ⅱ级,无明显药物禁忌,采用数字表法随机分为3组(n=20):对照组(C组)、高剂量氟比洛芬酯组(F1组)、低剂量氟比洛芬酯组(F2组)。所有患者均不用术前药,F1组在手术切皮前15min静脉注射氟比洛芬酯2mg/kg,F2组在手术切皮前15min静脉注射氟比洛芬酯1mg/kg,C组在手术切皮前15min静脉注射等量脂肪乳。记录麻醉诱导前(T_0)、气腹即刻(T_1)、气腹1h(T_2)、气腹2h(T_3)、解除气腹后10min(T_4)、术后24h(T_5)时的心率(HR)、平均动脉压(MAP),抽取动脉血行血气分析,计算氧合指数(OI),记录T_1、T_2、T_3及T_4时的气道峰压(Ppeak)、平均气道压(Pmean),计算肺顺应性(CL),分别于T_0、T_2、T_3及T_5时采集中心静脉血样,采用酶联免疫法测定血浆中TNF-ɑ、IL-6、IL-8的浓度。记录患者术中心血管不良反应发生情况。结果 F1组T_2、T_3及T_4时OI较C组升高(P<0.05)。3组T_2、T_3及T_4时CL较T_1均降低; F1组T_2、T_3及T_4时CL较C组升高(P<0.05)。3组T_2、T_3及T_5时TNF-ɑ,IL-6及IL-8较T_0时均升高(P<0.05); F1组T_2、T_3及T_5时TNF-ɑ,IL-6及IL-8较C组降低(P<0.05)。结论氟比洛芬酯可减轻腹腔镜手术老年患者的肺损伤,其机制可能与抑制气腹诱发炎性反应有关。

Objective To evaluate the lung protection of flurbiprofen axetil in elderly patients undergoing laparoscopic surgery.Methods Sixty patients of both sexes,aged≥65years,with body mass index of 18-29kg/m^2,of american society of anesthesiologists physical statusⅠorⅡ,scheduled for elective radical resection under general anesthesia,underwent laparoscopic gastrointestinal surgery were randomly divided into three groups(n=20)using a random number table:control group(group C),High-dose flurbiprofen axetil group(group F 1),Low-dose flurbiprofen axetil group(group F 2).All patients were not treated with preoperative drugs.Flurbiprofen axetil 2mg/kg was injected intravenously at 15 min before skin incision in group F 1,flurbiprofen axetil 1mg/kg was injected intravenously at 15 min before skin incision in group F 2,and the same amount of fat emulsion was injected intravenously at 15 min before skin incision in group C.Before induction of anesthesia(T 0),at the time of pneumoperitoneum(T 1),at 1h of pneumoperitoneum(T 2),at 2h of pneumoperitoneum(T 3),at 10min after the end of pneumoperitoneum(T 4),and at 24h after surgery(T 5),heart rate,mean arterial pressure were recorded,and blood sample were taken from the radial artery to calculate oxygenation index.The peak airway pressure(Ppeak)and airway plateau pressure(Pmean)were recorded at T 1,T 2,T 3,T 4 to calculate lung compliance(CL).Central venous blood samples were taken at T 0,T 2,T 3,T 5 to measure the concentrations of tumor necrosis factor-alpha,interleukin-6 and interleukin-8 in serum.The incidence of adverse cardiovascular events was recorded during surgery.Results Lung compliance(CL)at T 2,T 3 and T 4 decrease in all groups compared to T 1(P<0.05).Oxygenation index(OI)at T 2,T 3 and T 4 in group F 1 were higher than those in group C,while lung compliance(CL)at T 2,T 3 and T 4 in group F 1 were higher than those in group C.Tumor necrosis factor-alpha,interleukin-6 and interleukin-8 at T 2,T 3 and T 5 increased in all groups compared to T 0(P<0.05).Tumor necrosis factor-alpha,interleukin-6 and interleukin-8 at T 2,T 3 and T 5 in group F 1 were lower than those in group C.Conclusion Flurbiprofen axetil can reduce lung injury in elderly patients undergoing laparoscopic surgery,and its mechanism may be related to inhibition of inflammatory response induced by pneumoperitoneum.