珂立苏对术后顽固性肺不张患者血浆内源性肺表面活性物质的影响

Effect of calsurf on plasma pulmonary surfactant levels in patients with refractory postoperative atelectasis

目的 观察牛肺表面活性剂(CPS)珂立苏对术后顽固性肺不张患者血浆内源性肺表面活性物质的影响。方法选取嘉兴市第一医院2017年5月至2021年12月美国麻醉医师协会评级Ⅱ~Ⅲ级的30例术后顽固性肺不张患者为研究对象,按随机数字表法分为CPS组和对照组,每组15例。另选取同期在同院健康体检的15名健康志愿者为健康组。两组患者在全麻下行患侧支气管插管控压膨肺,其中CPS组在膨肺后经小儿纤维支气管镜引导至病变部位吹入1 mg/kg剂量的CPS。比较两组患者治疗前及治疗第7天血浆内源性肺表面活性物质(包括SP-A、SP-B、SP-C、SP-D)水平差异,以及其与健康组的差异;同时比较两组患者治疗后28 d病死率。结果 治疗前,CPS组与对照组患者血浆SP-A、SP-B、SP-C、SP-D水平比较,差异均无统计学意义(均P>0.05);治疗后,CPS组血浆SP-A水平明显降低(P<0.05),而SP-B、SP-C水平均明显升高(均P<0.05),其中SP-B、SP-C水平均明显高于对照组(均P<0.05)。CPS组、对照组患者治疗前血浆SP-A水平均明显高于健康组(均P<0.05),而SP-B水平均明显低于健康组(均P<0.05);3组对象血浆SP-C、SP-D水平比较,差异均无统计学意义(均P>0.05)。CPS组患者治疗第7天血浆SP-A、SP-B、SP-C水平均明显高于健康组(均P<0.05),对照组治疗第7天SP-A水平亦明显高于健康组(P<0.05);3组对象血浆SP-D水平比较,差异无统计学意义(P>0.05)。两组患者治疗后28 d病死率比较,差异无统计学意义(P>0.05)。结论 术后顽固性肺不张患者控压膨肺后吹入珂立苏能降低血浆SP-A水平,提高血浆SP-B、SP-C水平。

Objective To investigate the effect of calf pulmonary surfactant(CPS)on endogenous pulmonary surfactant levels in patients with postoperative refractory atelectasis after lung inflation.Methods From May 2019 to December 2021,30 patients with refractory postoperative atelectasis were randomly divided into CPS group and control group with 15 cases in each group.Under general anesthesia,the patient was intubated on the affected side of the bronchus to control pressure inflation;in CPS group 1 mg/kg CPS was blown into the affected site by pediatric fiberbronchoscope,while no CPS was given to control group.The plasma pulmonary surfactant(SP-A,B,C,D)levels before and 7 d after treatment were measured and compared between two groups and also compared with healthy subjects.Results Before treatment there were no significant differences in plasma pulmonary surfactant levels between CPS and control group(P>0.05).Compared those before treatment,the levels of SP-B and SP-C increased and SP-A decreased 7 d after treatment in CPS(P<0.05),while the levels of SP-B and SP-C after treatment were higher than those in control group(P<0.05).Before treatment the SP-A levels in CPS group and C group was significantly higher and SP-B level was lower than those in healthy control group(P<0.05).Compared with the healthy control group,the SP-A,SP-B and SP-C levels in CPS group 7d after treatment were significantly increased,and the SP-B level in control group were higher than that in healthy control group(P<0.05).Conclusion Insufflating CPS after lung inflation can increase the plasma levels of pulmonary surfactant SP-B and SP-C and reduce the level of SP-A in patients with refractory postoperative atelectasis,however,its clinical efficacy need to be further verified.