文献类型：期刊文献

中文题名：乌司他丁对肺癌切除术患者的肺保护效应

英文题名：Protective effects of ulinastatin on the lungs in patients with lung cancer undergoing lobectomy

作者：杨言苹[1];冯秀玲[1];王昱[1];弥海宁[2]

第一作者：杨言苹

机构：[1]甘肃中医学院附属医院麻醉科,兰州市730000;[2]甘肃省肿瘤医院肿瘤外科

第一机构：甘肃中医药大学第二附属医院

年份：2010

卷号：30

期号：5

起止页码：592

中文期刊名：中华麻醉学杂志

外文期刊名：Chinese Journal of Anesthesiology

收录：CSTPCD;;北大核心:【北大核心2008】；CSCD:【CSCD2011_2012】；

语种：中文

中文关键词：胰蛋白酶抑制剂;肺切除术;肺肿瘤

外文关键词：Trypsin inhibitors;Pneumonectomy;Lung neoplasms

摘要：目的 探讨乌司他丁对肺癌切除术患者的肺保护效应.方法 选择拟行肺叶切除术的Ⅲ期肺癌患者40例,年龄50～64岁,体重53～70 kg,ASA分级Ⅱ或Ⅲ级,随机分为2组（n=20）：对照组（C组）和乌司他丁组（U组）.均采用咪达唑仑-芬太尼-维库溴铵-异丙酚麻醉诱导,异丙酚-芬太尼-维库溴铵维持麻醉.麻醉诱导后单肺通气前,U组经30 min静脉注射乌司他丁10 000 U/kg（生理盐水稀释至20 ml）,C组给予等容量生理盐水.于麻醉诱导前即刻（T0）、单肺通气0.5 h（T1）、1 h（T2）、术后4 h（T3）、24 h（T4）时采集动脉血样5 ml,行动脉血气分析,计算呼吸指数（RI）,并测定血浆IL-6、IL-10和TNF-α浓度.结果 与T0时比较,C组T1～4时血浆TNF-α、IL-6浓度和RI升高,T1-3时血浆IL-10浓度升高（P＜0.05）,U组T2,3时血浆TNF-α和IL-6浓度升高,T1～4时血浆IL-10浓度和RI升高（P＜0.05）.与C组比较,U组血浆TNF-α、IL-6浓度和RI降低,血浆IL-10浓度升高（P＜0.05）.结论 乌司他丁10 000 U/kg可通过减轻全身炎性反应从而对肺癌切除术患者产生肺保护效应.
Objective To investigate the protective effects of ulinastatn on the lungs in patients with lung cancer undergoing lobectomy. Methods Forty ASA Ⅱ or Ⅲ patients with stage Ⅲ lung cancer, aged 50-64 yr weighing 53-70 kg undergoing lobectomy were randomly divided into 2 groups （ n = 20 each）： control group （group C） and ulinastatin group （group U）. In group U ulinastatin 10 000 U/kg in 20 ml normal saline was infused iv over 30 min immediately after induction of anesthesia. The patients were premedicated with diazepam 10 mg and scopolamine 0.3 mg im. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 4 μg/kg, TCI of propofol （Cp 4 μg/ml） and vecuronium 0.12 mg/kg and maintained with TCI of propofol （Cp 2-3 μg/ml） and intermittent iv boluses of fentanyl and vecuronium. The patients were intubated with double-lumen tube. Correct position of the tube was checked with fiberoptic bronchoscope. One-lung ventilation （OLV） was performed （VT 6-8 ml/kg, RR 10-16 bpm, I：R 1：2, FiO2 100% ）. PETCO2 was maintained at 35-45 mm Hg. Arterial blood samples were taken before anesthesia （T0, baseline）, at 0.5 h and 1 h of OLV （T1, T2 ） and 4 h and 24 h after operation （T3, T4 ）for blood gas analysis and determination of plasma TNF-α, IL-6 and IL-10 concentrations. Respiratory index （RI）was calculated. （RI= PA-a O2 /PaO2 ）.Results Compared with the baseline values at To, plasma TNF-α and IL-6 concentrations and RI at T1-4 and plasma IL-10 concentrations at T1-3 were all significantly increased in group C,while in group U plasma TNF-α and IL-6 concentrations at T2,3 and plasma IL-10 concentrations and RI at T1-4 were all significantly increased （ P 〈 0.05 ）. Plasma TNF-α and IL-6 concentrations and RI were significantly lower while plasma IL-10 concentration was significantly higher in group U than in group C （P 〈 0.05）.Conclusion Ulinastatin 10 000 U/kg can effectively protect the lungs in patients with lung cancer undergoing lobectomy by attenuating systemic inflammatory response.