盐酸戊乙奎醚对肺叶切除术患者单肺通气时血清炎性因子和气道黏蛋白MUC5AC表达的影响  

Effects of penehyclidine hydrochloride on the expression ofserum inflammatory factors and airway mucin MUC5AC during one-lung ventilation in patients undergoing pulmonary lobectomy

作　　者：颜君 于春锐[1] 孙立新[1] 时飞[1] 马福国[1] 王明山[1] YAN Jun;YU Chunrui;SUN Lixin;SHI Fei;MA Fuguo;WANG Mingshan(Department of Anesthesiology,Qingdao Municipal Hospital,Qingdao 266071,China)

机构地区：[1]山东省青岛市市立医院麻醉科,266071 [2]青岛市海慈医疗集团麻醉科

出　　处：《临床麻醉学杂志》2020年第9期837-841,共5页Journal of Clinical Anesthesiology

摘　　要：目的评估盐酸戊乙奎醚对肺叶切除术患者单肺通气(OLV)时血清炎性因子和气道黏蛋白MUC5AC表达的影响。方法择期行胸腔镜下肺叶切除术患者48例,男28例,女20例,年龄40~75岁,BMI 18~25 kg/m 2,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:对照组(C组)和盐酸戊乙奎醚组(P组),每组24例。P组于麻醉诱导前10 min静脉注射盐酸戊乙奎醚0.01 mg/kg,C组于相同时点静脉注射等容量生理盐水3 ml。分别于OLV前(T 1)、OLV 60 min(T 2)、术毕(T 3)、术后24 h(T 4)采集中心静脉血,采用ELISA法测定血清IL-1β、IL-6、TNF-α、NF-κB浓度;肺叶切除后即刻取肺组织,HE染色观察病理学结果;采用Image-Pro Plus图像分析软件进行图像分析,取平均积分光密度值表示气道黏蛋白MUC5AC含量。记录术后72 h内肺炎、肺不张、低氧血症等并发症及住院时间。结果与T 1时比较,T 2—T 4时两组血清中IL-1β、IL-6、TNF-α、NF-κB浓度明显升高(P<0.05)。与C组比较,T 2—T 4时P组血清中IL-1β、IL-6、TNF-α、NF-κB浓度明显降低(P<0.05),肺组织病理损伤明显减轻,气道黏蛋白MUC5AC含量明显下降(P<0.05)。两组术后72 h内肺炎、肺不张、低氧血症等并发症及住院时间差异均无统计学意义。结论盐酸戊乙奎醚可下调肺叶切除术患者OLV时血清炎性因子和气道黏蛋白MUC5AC的表达,减轻炎症反应和肺损伤。Objective To evaluate the effect of penehyclidine hydrochloride on the expression of serum inflammatory factors and airway mucin MUC5AC during one-lung ventilation(OLV)in patients undergoing pulmonary lobectomy.Methods Forty-eight patients undergoing thoracoscopic lobectomy,28 males and 20 females,aged 40-75 years,BMI 18-25 kg/m 2,ASA physical statusⅠorⅡ,were randomly divided into two groups with 24 cases in each:control group(group C)and penehyclidine hydrochloride group(group P).The patients were given intravenous penehyclidine hydrochloride of 0.01 mg/kg immediately 10 min before induction of anesthesia in group P,while the equal volume of normal saline was given in group C.Blood samples were collected from the central vein before OLV(T 1),at 60 min of OLV(T 2),the end of surgery(T 3),and 24 h after surgery(T 4).The concentrations of IL-1β,IL-6,TNF-α,and NF-κB were detected by ELISA.The lung tissue was taken immediately after lobectomy.The pathological results were observed by HE staining.Image analysis was performed with Image-Pro Plus image analysis software,and the average integrated optical density value was taken to represent the expression of MUC5AC in airway mucin.The complications such as pneumonia,atelectasis,hypoxemia within 72 h after surgery and the length of hospital stay were recorded.Results Compared with T 1,the concentrations of IL-1β,IL-6,TNF-α,and NF-κB in serum of two groups were significantly increased at T 2-T 4(P<0.05).Compared with group C,the concentrations of IL-1β,IL-6,TNF-α,and NF-κB in serum significantly decreased in both group at T 2-T 4(P<0.05).Compared with group C,the expression of MUC5AC protein in airway mucin was significantly decreased in group P(P<0.05).There was no statistical significance difference of complications such as pneumonia,atelectasis,hypoxemia within 72 h after surgery and the length of hospital stay between the two groups.Conclusion Penehyclidine hydrochloride can down-regulate the expression of serum inflamma￣tory factors and airway MUC5AC d

关 键 词：盐酸戊乙奎醚 气道黏蛋白MUC5AC 单肺通气 肺损伤 炎症 

分 类 号：R614[医药卫生—麻醉学]