乌司他丁联合右美托咪定对单肺通气患者的肺保护作用研究

Research on the lung protection of ulinastatin combined with dexmedetomidine in patients with single-lung ventilation

目的探讨乌司他丁联合右美托咪定对单肺通气患者的肺保护作用。方法选择2019年1月至2020年1月在南通大学附属海安医院需要进行胸腔镜下肺叶切除术的患者100例,按随机数字表法分为对照组(N组)、乌司他丁组(U组)、右美托咪定组(D组)、联合组(U+D组),各25例。麻醉诱导前各组分别给药。比较4组单肺通气开始时即刻(T1)、单肺通气后30 min(T2)、术毕(T3)的肺动态顺应性(Cdyn)、氧合指数、呼吸指数,给药前(T0)、T2、T3、手术后12 h(T4)的炎症因子水平,包括血清白细胞介素2(IL-2)、IL-6、IL-10和肿瘤坏死因子α(TNF-α)。记录4组术后肺部并发症(PPCS)发生情况和住院时间。结果从T1到T3时点,所有患者的Cdyn、氧合指数先下降后升高,呼吸指数先升高再下降(均P<0.05)。T3时点,U+D组的Cdyn、氧合指数显著高于N、U、D组[(31±4)ml/cmH2O(1 cmH2O=0.098 kPa)比(24±4)、(29±4)、(28±4)ml/cmH2O,(349±22)mmHg(1 mmHg=0.133 kPa)比(328±21)、(336±21)、(335±20)mmHg];呼吸指数显著低于N、U、D组[(0.46±0.10)比(0.97±0.13)、(0.87±0.14)、(0.89±0.12)](均P<0.05)。从T0到T4时点,4组患者所有炎症因子水平均先上升再下降(均P<0.05)。T3、T4时点,U+D组的促炎因子(IL-2、IL-6、TNF-α)水平显著低于N、U、D组,抗炎因子(IL-10)水平显著高于N、U、D组(均P<0.05)。U+D组的PPCS发生率显著低于U、D、N组,术后住院时间短于U、D、N组(均P<0.05)。结论乌司他丁、右美托咪定可在一定程度上减轻单肺通气对肺部造成的损伤,两药联用时效果最好。

Objective To explore the protective effect of ulinastatin combined with dexmedetomidine on patients with single-lung ventilation.Methods From January 2019 to January 2020,100 patients who needed thoracoscopic lobectomy in Hai'an Hospital Affiliated to Nantong University were selected.They were randomly divided into the control group(N group),ulinastatin group(U group),dexmedetomidine group(D group)and combination group(U+D group),with 25 cases in each group.Each group was given medicine before anesthesia induction.The dynamic lung compliance(Cdyn),oxygenation index and respiratory index at the beginning of single-lung ventilation(T1),30 min after single-lung ventilation(T2)and the end of operation(T3),and the levels of inflammatory factors at before administration(T0),T2,T3 and 12 h after operation(T4),including serum interleukin-2(IL-2),IL-6,IL-10 and tumor necrosis factor-α(TNF-α)in four groups were compared.The occurrence of postoperative pulmonary complications(PPCS)and the length of hospital stay in the four groups were recorded.Results From T1 to T3,the Cdyn and oxygenation index of all patients decreased firstly and then increased,and the respiratory index increased firstly and then decreased(all P<0.05).At T3,the Cdyn and oxygenation index in the U+D group were significantly higher than those in the N,U and D groups[(31±4)ml/cmH2O vs(24±4),(29±4),(28±4)ml/cmH2O;(349±22)mmHg vs(328±21),(336±21),(335±20)mmHg],respiration index was significantly lower than that of N,U,D group[(0.46±0.10)vs(0.97±0.13),(0.87±0.14),(0.89±0.12)](all P<0.05).From T0 to T4,all inflammatory factors levels in the four groups increased firstly and then decreased(all P<0.05).At T3 and T4,the levels of pro-inflammatory factors(IL-2,IL-6 and TNF-α)in the U+D group were significantly lower than those in the N,U,and D groups,and the anti-inflammatory factors(IL-10)level was significantly higher than that in the N,U and D groups(all P<0.05).The incidence of PPCS and length of postoperative hospital stay in U+D group were significantly lower than those in U,D and N groups(all P<0.05).Conclusion Ulinastatin and dexmedetomidine can reduce the lung damage caused by single-lung ventilation to a certain extent,and the effect is best when the two drugs are used in combination.