摘要
目的 观察远端肢体缺血预处理联合乌司他丁静脉输注对单肺通气（OLV）患者肺损伤的影响。方法 择期行单侧肺叶切除术或食管癌根治术行OLV患者60例。随机分为四组：对照组（C组）、缺血预处理组（IP组）、乌司他丁组（W组）、缺血预处理联合乌司他丁组（IPW组）,每组15例。四组患者术中均行OLV。IP组采用下肢缺血预处理,W组采用乌司他丁静脉输注处理,IPW组联合应用下肢缺血预处理及乌司他丁静脉输注处理,C组不作处理。记录手术情况。于气管插管后5 min（T0）,OLV后30 min（T1）、60 min（T2）、120 min（T3）,恢复双肺通气30min（T4）时采集血标本检测谷胱甘肽过氧化物酶（GPX）、过氧化氢酶（CAT）的活性,肺表面活性蛋白A（SP-A）,血清丙二醛（MDA）浓度;术后12、24、48、72 h用力肺活量（FVC）、第一秒用力肺活量（FEV1）及两者比值（FEV1/FVC）,同时监测动脉氧分压（Pa O2）、动脉二氧化碳分压（Pa CO2）。结果 与T0比较,C组、W组、IP组T1～T4时点及IPW组的T3时点的GPX及CAT活性下降,MDA及SP-A浓度上升;与C组比较,W组、IP组T2～T4时点及IPW组的T1～T4时点的GPX及CAT活性上升,MDA及SP-A浓度下降;W组、IP组及IPW组术后12、24、48、72 h的FVC（%）、FEV1（%）及FEV1/FVC（%）上升;与W组及IP组分别比较,IPW组的T2～T4时点的GPX及CAT活性升高,MDA及SP-A浓度降低,IPW组术后48、72 h的FVC（%）、FEV1（%）及FEV1/FVC（%）上升。以上差异均有统计学意义（P均〈0.05）。结论 缺血预处理或者乌司他丁处理对OLV的肺损伤有保护作用,联合应用效果更佳。
Objective To observe the protective effect of distal limb ischemia preconditioning （IP） combined with ulinas- tatin treatment on lung injury in patients with one lung ventilation（OLV）. Methods Sixty patients undergoing scheduled time unilateral lung resection or esophageal cancer radical resection with OLV in operation were enrolled in this study. The patients were randomly divided into four groups （n = 15 each ） ：control group （group C ）, ischemic preconditioning group （group IP） and ulinastatin treatment group （group W） , IP combined with ulinastatin treatment group （group IPW）. The patients in group IP were treated by lower limb IP ; the patients in group W were treated by intravenous infusion of ulinastatin ; the patients in group IPW were treated by lower limb IP combined with intravenous infusion of ulinastatin ; the patients in C group were not treated. The intraoperative information was recorded. The venous blood samples were taken at 5 min af- ter tracheal intubation （T0） , 30 min （ T1 ） ,60 min （ T2 ） , 120 rain （ T3 ） after OLV and 30 min after recovering two-lung ventilation （ T4 ） to detect the activities of glutathione peroxidase （GPX） and catalase （ CAT）, the concentrations of pulmonary surfactant protein A （SP-A） and serum malondialdehyde （MDA）. The forced vital capacities （ FVC）, forced vital capacity at the first second （ FEV1） and FEVI/FVC at 12-,24-,48- and 72-hour after operation were detected, and the arterial partial pressure of oxygen（ PaO2 ）and arterial partial pressure of carbon dioxide（ PaCO2 ）at the same time points were monitored. Results Compared with T0,the activities of GPX and CAT at T1 - T4 in groups C, W, IP and at T3 in group IPW decreased, and the concentrations of MDA and SP-A increased （ all P 〈 0.05 ）. Compared with group C at the corresponding time points, the activities of GPX and CAT at T2 - T4 in groups W, IP and at T1 - T4 in group IPW increased, and the concentrations of MDA and SP-A decreased （ all P 〈 0.05）. Compared with groups W and IP at the corresponding time points,the activities of GPX and CAT increased at T2 - T4 in group IPW, and the concentrations of MDA and SP-A decreased at 372 - T4 in group IPW （ all P 〈 0.05 ）. Compared with group C at the corresponding time points, FVC （ % ）, FEV1 （ % ） and FEV1/FVC （ % ） at 12-,24-,48- and 72-hour after surgery in groups W,IP and IPW increased（ all P 〈 0. 05 ）. Compared with groups W and IP at the corresponding time points, FVC （ % ）, FEV1（ % ） and FEV1/FVC （ % ） at 48- and 72-hour after operation in group IPW increased（ all P 〈 0.05 ）. Conclusion IP or ulinastatin treatment has a pro- tective effect on lung injury of OLV, and the effect of joint application is better.
出处
《中国临床研究》
CAS
2016年第9期1164-1167,共4页
Chinese Journal of Clinical Research
基金
广东省临床重点专科建设资金资助[粤卫文(2011)144]
关键词
肺损伤
远端肢体缺血预处理
乌司他丁
单肺通气
用力肺活量
第一秒用力肺活量
内源性抗氧化酶
肺表面活性蛋白
Lung injury
Ischemia preconditioning of distal limb
Ulinastatin
One lung ventilation
Forced vital capacity
Forced vital capacity at the first second
Endogenous antioxidant enzymes
Pulmonary surfactant protein
