不同液体急性高容量血液稀释对肺癌根治术患者围术期炎性及氧化应激反应的影响  

Effects of Acute Hypervolemic Hemodilution with Different Solutions on Perioperative Inflammatory Response and Oxidative Stress in Patients Undergoing Radical Surgery for Lung Cancer

作　　者：王永盛[1] 熊华平[1] 谢平[1] 

机构地区：[1]中国人民解放军第180医院麻醉科,福建泉州362000

出　　处：《南昌大学学报（医学版）》2014年第6期53-56,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨不同液体急性高容量血液稀释（AHHD）对肺癌根治术患者围术期炎性及氧化应激反应的影响。方法选取择期全身麻醉下行肺癌根治术患者80例,ASAⅠ或Ⅱ级,将其按随机数字表法分为4组：对照组（C组）、乳酸钠林格组（R组）、聚明胶肽组（P组）和6%羟乙基淀粉130/0.4组（H组）,每组20例。P组和H组分别于麻醉诱导前90min静脉滴注聚明胶肽和6%羟乙基淀粉130/0.4,速率20mL·kg-1·h-1,扩容量20mL·kg-1,R组和C组分别滴注乳酸钠林格液和生理盐水6-8mL·kg-1·h-1。分别于AHHD前（T0）,AHHD后即刻（T1）、2h（T2）和6h（T3）时采血,测定血清TNF-α、IL-6、IL-8、IL-10、NO、丙二醛（MDA）含量和超氧化物歧化酶（SOD）活性。结果与T0比较：T2—T3时C组、R组、P组和H组血清TNF-α、IL-6、IL-8、IL-10、NO含量及MDA活性升高,SOD含量降低（P〈0.05）;与C组比较：R组、P组和H组T2—T3时血清TNF-α、IL-6、IL-8、NO含量及MDA活性降低,IL-10及SOD含量升高（P〈0.05）;与R组比较：P组和H组T2—T3时血清TNF-α、IL-6、IL-8、NO含量及MDA活性降低,IL-10及SOD活性升高（P〈0.05）;与P组比较：H组T2—T3时血清IL-10及SOD含量升高,NO含量及MDA活性降低（P〈0.05）,血清TNF-α、IL-6及IL-8含量差异无统计学意义（P〉0.05）。结论术前应用乳酸钠林格液、聚明胶肽或6%羟乙基淀粉130/0.4行AHHD,可抑制肺癌根治术患者围术期炎性反应及氧化应激反应,且6%羟乙基淀粉130/0.4效果最佳。Objective To investigate the effects of acute hypervolemic hemodilution（AHHD）with different solutions on perioperative inflammatory response and oxidative stress in patients undergoing radical surgery for lung cancer.Methods Eighty ASA ⅠorⅡpatients undergoing elective radical surgery for lung cancer were randomly divided into four groups：control group（group C）,Ringer＇s sodium lactate solution group（group R）,polygeline group（group P）and6%hydroxyethyl starch 130/0.4group（group H）,with 20patients in each group.Patients in group P and group H were given intravenous infusion of polygeline and 6% hydroxyethyl starch130/0.4at 20mL·kg-1·h-1 90minutes before anesthesia induction（volume expansion 20mL·kg-1）,respectively.Patients in group R and group C were given intravenous infusion of Ringer＇s sodium lactate solution and normal saline at 6-8mL·kg-1·h-1,respectively.Blood samples were taken before AHHD（T0）,immediately after AHHD（T1）,2hours after AHHD（T2）and 6hours after AHHD（T3）for the detection of the serum levels of TNF-α,IL-6,IL-8,IL-10,NO,SOD and MDA.Results Compared with T0,serum levels of TNF-α,IL-6,IL-8,IL-10,NO and MDA increased but levels of SOD decreased at T2-T3in all groups（P〈0.05）.Compared with group C,serum levels of TNF-α,IL-6,IL-8,NO and MDA decreased but levels of IL-10and SOD increased at T2-T3in group R,P and H（P〈0.05）.Compared with group R,serum levels of TNF-α,IL-6,IL-8,NO and MDA decreased but levels of IL-10and SOD increased at T2-T3in group P and H（P〈0.05）.Compared with group P,serum levels of IL-10and SOD increased but levels of MDA decreased at T2-T3in group H（P〈0.05）.There were no significant differences in levels of TNF-α,IL-6and IL-8between group P and group H（P〈0.05）.Conclusion Preoperative AHHD with Ringer＇s sodium lactate solution,polygeline or 6% hydroxyethyl starch 130/0.4,especially6%hydroxyethyl starch 130/0.4,can inhibit perioperative inflammatory response and oxidative stress in patients undergo

关 键 词：羟乙基淀粉 聚明胶肽 急性高容量血液稀释 炎症 氧化应激 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]