乌司他丁对老年腔镜食管癌术后过度炎症反应的影响

Effect of Ulinastatin on Inflammatory Response in Elderly Patients with Esophageal Cancer after Thoracic Laparoscopic Surgery

目的:观察乌司他丁(UTI)对老年人胸腹腔镜食管癌术后过度炎症反应的影响。方法:将200例60~80岁行胸腹腔镜食管癌术患者均分为治疗组和对照组,治疗组于手术麻醉前30 min、术后当日及第1~4天静脉给予UTI,对照组仅进行常规处理;于术前1天、术后第1及7天时测定2组患者血清中性粒细胞弹性蛋白酶(NE)浓度,于手术前、术后第2及5天测定2组患者外周血CD4^+、CD8^+水平,于术后第1、2及5天时测定血清降钙素原(PCT)水平;比较2组患者术后肺部感染、胸腔引流等情况。结果:手术前,2组患者血清NE及PCT水平,外周血CD4^+、CD8^+水平比较,差异无统计学意义(P>0.05);2组患者手术后血清NE水平显著高于手术前(P<0.01),术后第1天血清NE水平显著高于术后第7天(P<0.01),治疗组升高幅度均小于对照组(P<0.05);2组患者术后第1及第2天血清PCT水平显著高于手术前(P<0.01),治疗组术后同时点PCT值均小于对照组,差异有统计学意义(P<0.05);2组患者术后外周血CD4^+、CD8^+水平均低于手术前(P<0.05),术后同时点治疗组均高于对照组、术后第2天低于第5天,差异有统计学意义(P<0.05);术后治疗组患者肺炎及上呼吸道感染发生率低于对照组,抗菌素使用时间及术后住院时间均短于对照组(P<0.05)。结论:UTI可有效抑制老年胸腹腔镜食管癌术后过度炎症反应,对术后肺部感染有一定的防治作用。

Objective:To observe the effect of ulinastatin(UTI)on excessive inflammatory response in elderly patients with esophageal cancer after thoracic laparoscopic surgery Methods:Two hundred aged 60~80 year old patients with esophageal cancer were divided into the treatment group and the control group.The treatment group was intravenously given UTI 30 min before the operation anesthesia,the surgery day after surgery and the first to fourth days after surgery.The group was only routinely treated.Serum neutrophil elastase(NE)concentrations were measured one day before surgery and the first and 7th days after surgery.Peripheral blood CD4^+and CD8^+levels were measured before the surgery,at the 1st,2nd and 5th postoperative day.Serum procalcitonin(PCT)levels were measured at the 1st,2nd and 5th postoperative day.Postoperative pulmonary infection and chest drainage were compared between the two groups.Results:Before the surgery,serum NE and PCT levels and peripheral blood CD4^+and CD8^+levels were not significantly different between the two groups(P>0.05).Serum NE levels were significantly higher in the two groups after surgery(P<0.01).The serum NE level was significantly higher on the first day than that on the 7th day after surgery(P<0.01).The increase extent of NE level in treatment group was lower than that in control group(P<0.05).On the first and second days after surgery,the serum PCT level was significantly higher than that before surgery(P<0.01),but its levels on fifth day was similar to the levels of the preoperative day(P>0.05).The PCT value of treatment group was lower than that of control group(P<0.05).The levels of CD4^+and CD8^+in peripheral blood were lower post-operation than pre-operation(P<0.05),and higher in treatment group than the control group,lower on 2 nd day post-operation than on fifth day post-operation(P<0.05).The incidence of pneumonia and upper respiratory tract infection in the postoperative treatment group was significantly lower than that in the control group.The antibiotic application time and postoperative hospital stay were shorter than the control group(P<0.05).Conclusion:UTI can effectively inhibit the excessive inflammatory response in elderly patients with esophageal cancer after thoracic laparoscopic surgery,and has a certain preventive effect on postoperative pulmonary infection.