依达拉奉联合乌司他丁对胸腔镜手术患者肺功能及肺表面活性蛋白A表达的影响  

Effect of edaravone combined with ulinastatin on pulmonary function and serum surfactant protein A(SP-A)level in patients undergoing thoracoscopic surgery

作　　者：姜敏[1] 华丽[1] 王雄[1] 邓静 何苗[1] 曾杰[2] Jiang Min;Hua Li;Wang Xiong;Deng Jing;He Miao;Zeng Jie(Department of Anesthesiology,Affiliated Hospital&Clinical Medical College of Chengdu University,Chengdu 610081,China;Department of Cardiothoracic Surgery,Affiliated Hospital&Clinical Medical College of Chengdu University,Chengdu 610081,China)

机构地区：[1]成都大学附属医院麻醉科,610081 [2]成都大学附属医院胸心外科,610081

出　　处：《中华临床医师杂志（电子版）》2020年第3期222-227,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：四川省卫生健康委普及应用项目(17PJ227)。

摘　　要：目的依达拉奉联合乌司他丁对胸腔镜手术患者肺功能及肺表面活性蛋白A表达的影响。方法选取择期行胸腔镜肺部肿瘤切除手术患者72例,随机分为4组:生理盐水对照组(对照组)、依达拉奉组、乌司他丁组和依达拉奉联合乌司他丁组(联合组)。每组分别在麻醉诱导前(T0)、单肺通气前即刻(T1)、手术结束时(T2)及术后24 h(T3)行动脉血气分析,计算氧合指数(OI)和呼吸指数(RI);采用全血自动分析仪测定多形核中性粒细胞(PMN)的数量;采用ELISA法检测血浆SP-A的浓度;记录血流动力学指标。随访患者术后住院时间及有无肺水肿、肺部感染等肺部并发症。结果4组患者血流动力学指标差异无统计学意义。T2时点,联合组、依达拉奉组及乌司他丁组OI较对照组均明显增高(P<0.05),联合组OI又显著高于依达拉奉组及乌司他丁组(P<0.05);RI和PMN则呈相反趋势(P<0.05)。T3时点,联合组SP-A的表达显著高于对照组、依达拉奉组及乌司他丁组(P<0.05),而对照组、依达拉奉组及乌司他丁组间差异无统计学意义。结论联合应用依达拉奉和乌司他丁较单一用药方案更能改善胸腔镜手术患者术后肺功能,可能与抑制PMN的聚集和上调血SP-A的表达有关。Objective To observe the effect of edaravone combined with ulinastatin on pulmonary function and serum level of surfactant protein A(SP-A)in patients undergoing thoracoscopic surgery.Methods Seventy-two patients scheduled for thoracoscopic surgery were divided into four groups:saline group(control group,n=18);edaravone group(n=18);ulinastatin group(n=18);and edaravone plus ulinastatin group(EU group,n=18).Pulmonary function and SP-A level were evaluated at four time points for each patient:before induction(T0),prior to one-lung ventilation(T1),at the end of operation(T2),and 24 h after operation(T3).Blood specimens were obtained at each time point to test oxygenation index(OI),respiratory index(RI),and the number of polymorphonuclear neutrophils(PMN).ELISA was employed to detect serum level of SP-A.Intraoperative hemodynamic changes,postoperative complications,and hospitalization time were recorded.Results There was no significant difference in hemodynamics among the four groups at all four time points.At T2,OI in the EU group,edaravone group,and ulinastatin group significantly increased compared with the control group(P<0.05),and OI in the EU group was significantly higher than that in the edaravone group and ulinastatin group(P<0.05),while RI and the number of PMN showed opposite changes(P<0.05).At T3,SP-A serum level in the EU group was significantly higher than those in the control group,edaravone group,and ulinastatin group(P<0.05),although there was no significant difference among the control group,edaravone group,and ulinastatin group.Conclusion The effect of combination treatment of edaravone and ulinastatin is superior to monotherapy with either of them in patients undergoing thoracoscopic surgery,which might be related to the inhibition of PMN aggregation and up-regulation of serum SP-A level.

关 键 词：依达拉奉 乌司他丁 单肺通气 多形核中性粒细胞 肺表面活性蛋白A 

分 类 号：R655[医药卫生—外科学]