| 保护性肺通气联合药物对围术期肺癌患者的影响 |
| 投稿时间：2015-11-20 修订日期：2015-11-30 点此下载全文 |
| 引用本文：张亚军,郑兰兰,郑琴,柴伟.保护性肺通气联合药物对围术期肺癌患者的影响[J].医学研究杂志,2016,45(5):111-114 |
| DOI：
10.11969/j.issn.1673-548X.2016.05.027 |
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| 中文摘要:目的 探讨保护性通气联合药物对肺癌患者围术期的影响。方法 80例ASA分级Ⅰ~Ⅱ级拟行肺癌切除术的患者,随机分为4组(n=20):空白对照组(R组),保护性通气组(A组),保护性通气+依达拉奉处理组(B组),保护性通气＋乌司他丁处理组(C组)。所有患者行常规全身麻醉,双腔支气管插管辅助通气,R组设定潮气量为9ml/kg,单肺通气(one-lung ventilation,OLV)前10min给予100ml氯化钠注射液静脉滴注,A组在OLV前10min给予保护性通气策略:潮气量6ml/kg+5cmH2OPEEP,并等量氯化钠注射液静脉滴注,B组在OLV前10min行A组通气方式,给予0.5mg/kg依达拉奉注射液稀释于等量氯化钠注射液静脉滴注,C组在OLV前10min行A组通气方式,并给予5000U/kg乌司他丁稀释于等量氯化钠注射液静脉滴注。分别于麻醉诱导后(T0)、OLV60min(T1)、术后120min(T2)抽取动脉血5ml,测定血清中肺表面活性蛋白D(SP-D)、肿瘤坏死因子α(TNF-α)、白介素8(IL-8)、超氧化物歧化酶(SOD)及丙二醛(MDA)水平。结果 在T1、T2时间点,与R组比较,A、B、C组的SP-D、TNF-α、IL-8水平降低(P<0.05),与A组比较,B、C组降低(P<0.05),B组和C组差异无统计学意义(P>0.05);T1、T2时间点,A、B、C组的MDA水平较R组降低,其中B、C组较A组降低(P<0.05),B组和C组差异无统计学意义(P>0.05),A、B、C组的SOD水平较R组升高(P<0.05),其中B、C组较A组升高(P<0.05),B组和C组差异无统计学意义(P>0.05)。结论 肺保护性通气联合药物应用于肺癌患者能显著降低术中气道压力,改善氧合状况,有效抑制炎性反应和氧化应激反应,发挥肺保护作用,其中肺保护性通气联合依达拉奉药物干预与肺保护性通气联合乌司他丁药物差异无统计学意义。 |
| 中文关键词:单肺通气 依达拉奉 乌司他丁 |
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| Effects of Protective Ventilation and Drugs on Peri-operative Lung Cancer Patients |
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| Abstract:Objective To investigate the effects of protective ventilation and drugs on peri-operative lung cancer patients. Methods We studied 80 cases adult patients undergoing thoracic surgery with OLV in lateral decubitus position. The patients were randomly divided into four groups(n=20): control group (group R),lung protective ventilation group(group A), lung protective ventilation and edaravone group (group B), Lung protective ventilation and ulinastatin group (group C). All patients were mechanically ventilated after double-lumen tube endotracheal intubation. In R group, all cases received a VT of 9ml/kg. In A group, all cases received OLV with a VT of 6ml/kg and positive end-expiratory pressure (PEEP) preset 5cm H2O. In B group, all cases received ventilation mode like A's and 0.5mg/kg edaravone intravenous infusion within 10 minute before OLV. In C group, all cases received ventilation mode like A's and 5000U/kg ulinastatin intravenous infusion within 10 minute before OLV. Intra-arterial blood were drawn after induction (T 0)、60 min after OLV (T1) and 120min after operation (T2) to determine the levels of SP-D,TNF-α,IL-8,MDA,SOD. Results There were no significant differences in SP-D,TNF-α,IL-8,SOD and MDA levels at T0 in four groups. At the time point of T1,T2 ,compared with R group, there was decrease in SP-D,TNF-α and IL-8 in other group (P<0.05),especially in B and C group (P<0.05),while B group and C group were no significant differences. At T1 and T2, compared with R group, there was decrease in MDA in other Group (P<0.05), but SOD was increased, especially in B,C group (P<0.05). Conclusion Lung protective ventilation and drugs can effectively improve postoperative artericl oxygenation and reduce airway pressure for patients, and attenuate the systemic inflammatory response in the early period of pulmonary injury. |
| keywords:One-lung ventilation Edaravone Ulinastatin |
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