N-乙酰半胱氨酸对胸外科肺叶切除术后肺保护的临床研究

Study of protective effect of N-acetylcysteine on lung in patients after thoracoscopic lobectomy

目的观察N-乙酰半胱氨酸注射液(NAC)对胸外科肺叶切除术后患者的肺保护作用及可能机制。方法选取40例胸腔镜肺叶切除术的患者,随机分为实验(N-乙酰半胱氨酸,A组,下同)和对照(生理盐水,B组,下同)组,每组各20例。A组术后静脉滴注N-乙酰半胱氨酸(8g/次,qd),B组术后静脉滴注生理盐水(250mL/d);采集患者麻醉诱导前(T0),术后8h(T1),术后24h(T2),术后48h(T3)静脉血标本,采用酶联免疫吸附法(Elisa)测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超氧化物歧化酶(SOD)水平。结果T0时间点,两组血浆TNF-α、IL-6、SOD浓度之间无显著差异(P>0.05);与T0比较,两组血浆TNF-α、IL-6浓度在T1-3明显上升,SOD浓度明显下降(P<0.05),A组T1~3血浆TNF-α、IL-6浓度均明显低于B组(P<0.05),SOD明显高于B组(P<0.05)。结论NAC在肺叶切除术后对肺脏具有一定的保护作用,其机制可能与NAC抑制炎症因子的表达和减轻氧化应激有关。

Objective To observe the protective effect of N-acetylcysteine injection(NAC)on lung in patients after thoracic lobectomy and to explore its possible mechanism.Methods 40 patients after thoracoscopic lobectomy were randomly divided into the experimental group(N-acetylcysteine,the group A)and the control group(normal saline,the group B).The group A received intravenous infusion of N-acetylcysteine(8g/times,qd),and the group B received intravenous infusion of normal saline(250mL/d).Their blood sample were collected at the time of before anesthesia induction(T0),8h(T1),24h(T2),and 48h(T3)after operation.Plasma levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and superoxide dismutase(SOD)were measured by enzyme-linked immunosorbent assay(Elisa).Results There was no significant difference in plasma TNF-αand IL-6 and SOD concentrations between the two groups at T0(P>0.05).Compared with T0,the concentrations of TNF-αand IL-6 at T1-3 and SOD decreased significantly in both groups(P<0.05).The concentrations of TNF-αand IL-6 at T1-3 were significantly lower than those in the group B(P<0.05).SOD was significantly higher than that in the group B(P<0.05).Conclusion NAC has a protective effect on lung after lobectomy,and its mechanism may be related to the inhibition of inflammatory factor expression by NAC and the reduction of oxidative stress.