复方红景天防治胸部手术后急性肺损伤的前瞻性研究

Early use of Chinese drug rhodiola compound for patients with thoracic operation in prevention of ALI

目的 :探索高原地区胸部手术后急性肺损伤的发病趋势和早期防治效果。方法 :选择拟行食管癌切除术 36例 ,随机分为对照组 (CG ,n =2 0 )和防治组 (TG ,n =16 )。CG术前常规处理 ,TG加服复方红景天 (RCO ,3.2g·d 1) ,平均 ( 8.5± 1.3)d。两组均进行术前、后动脉血气、生化全项等 33项多脏器功能指标检查 ,比较两组指标参数的变化。结果 :术前两组PaO2 /FiO2 均介于 2 80～ 370mmHg之间 ,两组相比P >0 .0 5。术后第 1、3、5天CGPaO2 /FiO2 依次为 15 1.97,16 2 .6 2 ,2 0 8.90mmHg ,TGPaO2 /FiO2依次为 16 2 .38,182 .4 5 ,2 5 1.36mmHg,与术前相比均P <0 .0 1;术后第 5天CG与TGAaDO2 相比有显著差异 (P <0 .0 5 )。术后所有病人均可诱发SIRS、ALI,大部可达到ARDS的血气标准。CG术后合并ARDS1例治愈 ,MODS1例术后第 10天死亡 ,全组死亡率为 2 .8%。结论 :目前通用的国内外ARDS/MODS诊断标准不适用于中度高原以上地区 ;早期应用RCO对预防胸部手术后急性肺损伤效果显著。

Objective:To study the pathogenesis and the preventive treatment of acute lung injury (ALI) caused by thoracic operation on the moderate high altitude.Methods: 36 patients with esophageal cancer were chosen and divided into contrasting group (CG, n =20) and treating group (TG, n =16). The routine treatment in both CG and TG was similar, but 3.2 grams of rhadiola compound (RCO) were used in TG every day for a period of 7-10 days preoperatively. 33 organ indexes were examined and compared in each groups. Results: PaO 2/FiO 2 of the two groups was 280-370 mmHg before operation and there were 5 cases PaO 2/FiO 2≤300 mmHg in CG and 3 cases in TG. The parameters of PaO 2/FiO 2 after operation 1st,3rd and 5th day between CG and TG were 151.97, 162.62, 208.90 and 162.38, 182.45, 251.36 mmHg respectively and its values were significantly lower than that of before operation ( P <0.01). Both groups reached ALI criteria and most of them reached the criteria of ARDS. The death rate of two groups were 2.8%Conclusion The present common diagnostic criteria of ARDS does not apply to the moderate high altitude, and RCO may protect against major risk factors of ALI/ARDS caused by thoracic operations.