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目的探讨食管癌根治术患者行单肺通气(OLV)期间应用乌司他丁联合保护性肺通气模式对肺内分流及炎性因子的影响。方法将48例择期行肺切除手术的患者分为保护性通气组(P组)和乌司他丁联合保护性通气组(U组)各24例,分别记录OLV前(T0)、OLV后30min(T1)及60min(T2)、双侧通气后(T3)的气道峰压(Ppeak)和肺内分流(Qs/Qt)值,并测定各时点的血清IL-8、TNF-a水平。结果 (1)两组患者在术中各时点的Ppeak和Qs/Qt值变化趋势基本相同,而U组稍低于P组,但差异均无统计学意义(P>0.05)。(2)两组患者在术中的血清TNF-a和IL-8水平均明显高于OLV前,差异有统计学意义(P<0.05);而P组患者的血清TNF-a水平还明显高于U组患者,且P组患者在T2、T3时点的血清IL-8水平亦明显高于U组患者,差异均有统计学意义(P<0.05)。结论 OLV期间,乌司他丁联合保护性通气可以明显减轻炎症反应,有效减轻肺损伤。
Objective To investigate the effects of ulinastatin combined with protective pulmonary ventilation on pulmonary shunt and inflammatory factors in patients with radical resection of esophageal cancer undergoing single lung ventilation (OLV). Methods Forty-eight patients undergoing elective pneumonectomy were divided into protective ventilation group (P group) and ulinastatin combined protective ventilation group (U group), 24 cases were recorded before OLV (OL) and 30 minutes after OLV (Ppeak) and pulmonary shunt (Qs / Qt) were measured at different time points (T1), 60min (T2) and bilateral ventilation (T3). Serum levels of IL-8 and TNF- . Results (1) The trend of Ppeak and Qs / Qt in the two groups were basically the same at different time points, while the U group was slightly lower than the P group, but the difference was not statistically significant (P> 0.05). (2) The levels of serum TNF-a and IL-8 in the two groups were significantly higher than those before OLV (P <0.05), while the level of serum TNF-a in group P was also significantly higher In group U, the level of serum IL-8 in group P was significantly higher than that in group U at T2 and T3 (P <0.05). Conclusions During OLV, ulinastatin combined with protective ventilation can significantly reduce the inflammatory response and reduce lung injury effectively.