乌司他丁联合右美托咪定对单肺通气肺叶切除肺癌患者血清免疫指标影响  

Effects of ulinastatin combined with dexmedetomidine on serum immune indexes in patients with lung cancer undergoing one-lung ventilation lobectomy

作　　者：陶广华 吴勇[2] 张文龙 邓义江 李泉霖 刘文值 TAO Guanghua;WU Yong;ZHANG Wenlong;DENG Yijiang;LI Quanlin;LIU Wenzhi(Xichang People’s Hospital,Xichang 615000,Sichuan,China;Panzhihua Central Hospital,Panzhihua 617067,Sichuan,China;The Affiliated Hospital of Panzhihua College,Panzhihua 617000,Sichuan,China)

机构地区：[1]西昌市人民医院,四川西昌615000 [2]攀枝花市中心医院,四川攀枝花617067 [3]攀枝花学院附属医院,四川攀枝花617000

出　　处：《现代中西医结合杂志》2022年第13期1775-1780,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：四川省医学青年创新课题(Q15052);四川省教育厅课题项目(18ZB0344)。

摘　　要：目的探讨乌司他丁联合右美托咪定对单肺通气肺叶切除肺癌患者血清免疫指标的影响。方法选择2015年12月—2019年6月在攀枝花学院附属医院行电视胸腔镜肺叶切除术单肺通气肺癌患者80例,随机分为4组,每组20例。4组患者均行静脉复合全身麻醉。诱导前30 min,对照组缓慢滴注0.9%氯化钠注射液100 mL;乌司他丁组缓慢输注乌司他丁注射液5000 IU/kg(总量100 mL);右美组先按1μg/(kg·h)泵注2μg/mL右美托咪定注射液至诱导完成,再按0.5μg/(kg·h)泵注至手术结束(总量约100 mL);乌司他丁+右美组分别输注乌司他丁注射液5000 IU/kg及4μg/mL右美托咪定注射液各50 mL。记录各组患者手术时间、单肺通气时间、机械通气时间、失血量;采集麻醉诱导前30 min、手术开始2 h、手术后24 h及手术后48 h各组患者外周静脉血,检测血清白细胞介素-2(IL-2)、白细胞介素-4(IL-4)、干扰素-γ(IFN-γ)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、补体C3、补体C4、超敏C反应蛋白(hs-CRP)、CD4+及CD8+水平。结果各组间手术时间、单肺通气时间、机械通气时间、失血量比较差异均无统计学意义(P均>0.05)。麻醉诱导前30 min,4组患者各项指标比较差异均无统计学意义(P均>0.05);手术开始2 h、手术后24 h及手术后48 h,乌司他丁+右美组患者血清IL-2、IFN-γ、IgG、IgA水平均明显高于同时点其他组(P均<0.05),血清IL-4、补体C3、补体C4、hs-CRP水平均明显低于同时点其他组(P均<0.05);手术开始2 h、手术后24 h及手术后48 h,各组患者CD4+、CD8+均逐渐降低,但乌司他丁+右美组患者CD4+、CD8+均明显高于同时点其他组(P均<0.05)。结论乌司他丁联合右美托咪定可显著增强单肺通气肺叶切除肺癌患者的免疫调节功能,对改善此类手术患者预后具有积极作用。Objective It is to investigate the effect of ulinastatin combined with dexmedetomidine on serum immune indexes in patients with lung cancer undergoing lobectomy with one-lung ventilation.Methods A total of 80 patients with lung cancer who underwent video-assisted thoracoscopic lobectomy with single-lung ventilation in the Affiliated Hospital of Panzhihua University from December 2015 to June 2019 were selected and randomly divided into 4 groups,with 20 cases in each group.All patients in the 4 groups received intravenous combined general anesthesia.30 min before induction,the control group was slowly infused with 0.9%sodium chloride injection 100 mL;the ulinastatin group was slowly infused with ulinastatin injection 5000 IU/kg(total 100 mL);the dexmedetomidine group was first injected with 2μg/mL dexmedetomidine injection at 1μg/(kg·h)until the induction was completed,and then at 0.5μg/(kg·h)until the end of the operation(the total amount was about 100 mL);the ulinastatin+dexmedetomidine group received 50 mL of ulinastatin injection 5000 IU/kg and 4μg/mL dexmedetomidine injection,respectively.The operation time,one-lung ventilation time,mechanical ventilation time,and blood loss were recorded in each group;the peripheral venous blood was collected 30 minutes before anesthesia induction,2 hours,24 hours and 48 hours after the operation,and the levels of serum interleukin-2(IL-2),interleukin-4(IL-4),interferon-γ(IFN-γ),immunoglobulin G(IgG),immunoglobulin A(IgA),complement C3,complement C4,high-sensitivity C-reactive protein(hs-CRP),CD4+and CD8+were detected.Results There was no significant difference in operation time,one-lung ventilation time,mechanical ventilation time and blood loss among the four groups(all P>0.05).30 minutes before induction of anesthesia,there was no significant difference in the indexes among the four groups(all P>0.05).The levels of serum IL-2,IFN-γ,IgG,and IgA at 2 hours after surgery,24 hours after surgery,and 48 hours after surgery in the ulinastatin+dexmedetomidine group were

关 键 词：乌司他丁 右美托咪定 单肺通气 免疫指标 

分 类 号：R734.2[医药卫生—肿瘤]