乌司他丁对单肺通气和体外循环下行胸腔镜心脏手术患者肺功能的影响

发布时间：2019-03-20 12:44

【摘要】：目的探讨乌司他丁对单肺通气(OLV)和体外循环(CPB)下行胸腔镜心脏手术患者肺功能的影响。方法选择择期行胸腔镜CPB心脏手术患者54例,随机分为观察组(n=27)和对照组(n=27)。观察组患者麻醉诱导后静脉滴注乌司他丁1万U/kg,CPB期间持续肺动脉灌注低温含氧血混合乌司他丁2万U/kg(与氧合机器血混合);对照组在相应时段同样方法使用等容量氯化钠溶液。采集麻醉诱导后双肺通气(T1),CPB结束后双肺通气(T2),CPB结束后4 h(T3)、8 h(T4)、24 h(T5)的动脉血气,计算Pa O2/Fi O2、Cs、Cd、RI并记录单肺通气时间和低氧血症的发生,以及检测T1、T4、T5时间点的炎性因子(IL-6、TNF-α、WBC、中性粒细胞比率);记录机械通气时间、ICU时间、术后住院时间。结果观察组术后机械通气时间短于对照组(P=0.04),观察组低氧血症的发生率明显低于对照组(P=0.03);两组患者平均动脉压、心率等比较差异均无统计学意义(P0.05).术后8、24 h Pa O2/Fi O2观察组高于对照组(均P0.05),术后8、24 h RI观察组低于对照组(均P0.05);术后4 h的Cd、Cs观察组明显高于对照组(P0.05);术后8 h血浆TNF-α、IL-6、WBC、中性粒细胞比率水平观察组低于对照组,差异有统计学意义(P0.05)。结论乌司他丁对单肺通气和CPB下行胸腔镜心脏手术患者肺功能损伤具有一定的保护作用。
[Abstract]:Objective to investigate the effect of ulinastatin on pulmonary function in patients undergoing thoracoscopic cardiac surgery with one-lung ventilation (OLV) and cardiopulmonary bypass (CPB). Methods 54 patients undergoing thoracoscopic CPB cardiac surgery were randomly divided into observation group (n = 27) and control group (n = 27). The patients in the observation group were given ulinastatin 10 000 U / kg intravenously after induction of anesthesia. The pulmonary artery was continuously perfused with oxygen-containing blood and Ulinastatin 20 U/kg (mixed with oxygenation machine blood). The control group was treated with equal volume sodium chloride solution at the same time. Arterial blood gases were collected at 4 h (T 3), 8 h (T 4) and 24 h (T 5) after anesthesia induced bi lung ventilation (T 1), CPB). Pa O2/Fi O 2, Cs, CD were calculated. RI also recorded the duration of one-lung ventilation and the occurrence of hypoxemia, and measured the inflammatory factors (IL-6,TNF- 伪, WBC, neutrophil ratio) at T1, T4 and T5 time points. Mechanical ventilation time, ICU time and postoperative hospital stay were recorded. Results the duration of mechanical ventilation in the observation group was shorter than that in the control group (P < 0. 04). The incidence of hypoxemia in the observation group was significantly lower than that in the control group (P < 0. 03). There was no significant difference in mean arterial pressure and heart rate between the two groups (P0.05). The Pa O2/Fi O2 in observation group was higher than that in control group at 8 hours after operation (all P0.05), and the RI observation group at 24 hours after operation was lower than that in control group (all P0.05), and the Cd,Cs observation group at 4 hours after operation was significantly higher than that in control group (P0.05). The levels of plasma TNF- 伪 and IL-6,WBC, neutrophil ratio in the observation group were lower than those in the control group at 8 h after operation, the difference was statistically significant (P0.05). Conclusion Ulinastatin has a protective effect on lung function injury in patients undergoing one-lung ventilation and CPB-assisted thoracoscopic cardiac surgery.
【作者单位】：广州医科大学附属广州市第一人民医院麻醉科;广东省心血管病研究所麻醉科;
【分类号】：R614

【参考文献】