甲强龙联合乌司他丁预处理对食管癌根治术麻醉所致炎性肺损伤的保护作用研究  

Protective effect of methylprednisolone combined with ulinastatin pretreatment on inflammatory lung injury induced by anesthesia for esophageal cancer

作　　者：王棣馨[1] 谢先丰[1] 蒋蓉娟[1] 曹慧灵[1] 郑孝振 WANG Di-xin;XIE Xian-feng;JIANG Rong-juan;CAO Hui-ling;ZHENG Xiao-zhen(Department of Anesthesiology, Second People’s Hospital of Chengdu, Chengdu, 610000, Sichuan Province, China;Department of Anesthesiology, The First Affiliated Hospital of Henan University, 475000, Kaifeng, Henan Province, China)

机构地区：[1]成都市第二人民医院麻醉科,四川成都610000 [2]河南大学第一附属医院麻醉科,河南开封475000

出　　处：《海南医学院学报》2019年第12期940-943,共4页Journal of Hainan Medical University

基　　金：国家自然科学基金项目(81600940)~~

摘　　要：目的:探究甲强龙联合乌司他丁预处理对单肺通气麻醉所致炎性肺损伤的保护作用方法:选择我院收治的食道癌根治手术患者120例,随机分为对照组、甲强龙组、乌司他丁组及甲强龙联合乌司他丁预处理组,于单肺通气前(T0)、通气后30 min(T1)、通气结束后60 min(T2),采用ELISA法检测患者炎性因子TNF-α、IL-8、IL-10水平,并检测各监测点的平均气道压(Pmean)及手术前后氧合指数(PaO2/FiO2)及术后引流管的拔除时间、引流量及痰量.结果:与对照组相比,其余3组均可降低食道癌患者血液中TNF-α、IL-8水平,提高IL-10水平,使氧合指数升高(P<0.05).但乌司他丁联合甲强龙组对在降低患者血清炎症因子水平及提高氧合指数方面明显优于甲强龙和乌司他丁组(P<0.05).甲强龙联合乌司他丁预处理患者的引流管拔除时间、引流量及痰量也明显小于对照组、甲强龙组、乌司他丁组.结论:甲强龙联合乌司他丁对食管癌患者根治术所致的炎性肺损伤具有协同保护作用,值得在临床一线推荐使用.Objective: To investigate the protective effect of methylprednisolone combined with ulinastatin pretreatment on inflammatory lung injury induced by single-lung ventilation. Methods: Selective esophagus admitted to our hospital from January 2016 to December 2017 120 patients with radical cancer surgery were randomly divided into control group, methylprednisolone group, ulinastatin group and methylprednisolone combined with ulinastatin pretreatment group, before single lung ventilation (T0), 30 minutes after ventilation (T1). 60 min (T2) after the end of ventilation, ELISA method was used to detect the levels of inflammatory factors TNF-α, IL-8 and IL-10, and the mean airway pressure (Pmean) at each monitoring point and the oxygenation index before and after surgery were measured.(PaO 2 / FiO 2) and the extraction time, drainage volume and sputum volume of the drainage tube. Results: Compared with the control group, the other three groups can reduce the levels of TNF-α and IL-8 in the blood of patients with esophageal cancer and improve IL. The level of -10 increased the oxygenation index ( P <0.05). However, ulinastatin combined with methylprednisolone group was significantly better than methylprednisolone and ursin in reducing serum inflammatory factor levels and increasing oxygenation index. The statin group ( P < 0.05), in addition, the drainage tube of patients with methylprednisolone combined with ulinastatin pretreatment Time, drainage and sputum amount significantly less than the other three groups. Conclusion: A strong ketone combined with ulinastatin has synergistic protective effect on inflammatory lung injury caused by radical operation in patients with esophageal cancer. It is worthy of recommendation in the first line.

关 键 词：炎性肺损伤 甲强龙 乌司他丁 食管癌手术 麻醉 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]