CAJ | 학술논문

目的评价术前雾化吸入布地奈德对开胸手术患者单肺通气时炎性反应的影响.方法肺叶切除术患者50例,年龄20 ～ 60岁,体重50 ～ 80 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组(n=25):对照组(C组)和布地奈德组(B组).术前C组雾化吸入生理盐水20 min;B组雾化吸入布地奈德1 mg 20 min.分别于单肺通气前(T1)、单肺通气结束后30 min(T2)、术后24 h(T3)和48 h(T4)时采集动脉血样,进行血气分析；采集静脉血样,采用ELISA法测定血清TNF-α、IL-1、IL-6、IL-8和IL-10的浓度.分别于T1和T2时,记录气道峰压、气道平台压和肺顺应性,采用ELISA测定支气管肺泡灌洗液TNF-α、IL-1、IL-6、IL-8和IL-10浓度.结果与C组比较,B组T1和T2时气道峰压和气道平台压降低,肺顺应性升高,T2时支气管肺泡灌洗液中TNF-α、IL-1、IL-6和IL-8的浓度降低,T2-4时氧合指数升高,血清TNF-α、IL-1、IL-6和IL-8的浓度降低(P＜0.05),各时点PaCO2比较差异无统计学意义(P＞0.05).结论术前雾化吸入布地奈德可抑制开胸手术患者单肺通气时的炎性反应,有助于改善肺功能.
목적 평개술전무화흡입포지내덕대개흉수술환자단폐통기시염성반응적영향.방법 폐협절제술환자50례,년령20 ～ 60세,체중50 ～ 80 kg,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위2조(n=25):대조조(C조)화포지내덕조(B조).술전C조무화흡입생리염수20 min;B조무화흡입포지내덕1 mg 20 min.분별우단폐통기전(T1)、단폐통기결속후30 min(T2)、술후24 h(T3)화48 h(T4)시채집동맥혈양,진행혈기분석；채집정맥혈양,채용ELISA법측정혈청TNF-α、IL-1、IL-6、IL-8화IL-10적농도.분별우T1화T2시,기록기도봉압、기도평태압화폐순응성,채용ELISA측정지기관폐포관세액TNF-α、IL-1、IL-6、IL-8화IL-10농도.결과 여C조비교,B조T1화T2시기도봉압화기도평태압강저,폐순응성승고,T2시지기관폐포관세액중TNF-α、IL-1、IL-6화IL-8적농도강저,T2-4시양합지수승고,혈청TNF-α、IL-1、IL-6화IL-8적농도강저(P＜0.05),각시점PaCO2비교차이무통계학의의(P＞0.05).결론 술전무화흡입포지내덕가억제개흉수술환자단폐통기시적염성반응,유조우개선폐공능.
Objective To evaluate the effect of inhaled budesonide before operation on the inflammatory responses to one-lung ventilation (OLV) in patients undergoing thoracotomy.Metheds Fifty ASA Ⅰ or Ⅱ physical status patients,aged 20-60 yr,weighing 50-80 kg,undergoing pulmonary lobectomy,were randomly divided into 2 groups (n =25 each):control group (group C) and budesonide group (group B).The patients inhaled normal saline and budesonide 1 mg for 20 min before operation in groups C and B,respectively.Before OLV (T1),at 30 min after OLV (T2),and at 24 and 48 h after operation (T3-4),arterial blood samples were collected for blood gas analysis and venous blood samples were collected for determination of serum concentrations of TNF-α,IL-1,IL-6,IL-8 and IL-10.Oxygenation index was calculated at T1-4.Airway peak pressure,airway plateau pressure and lung compliance were recorded at T1 and T2.Broncho-alveolar lavage fluid (BALF) of the ventilated lung was collected at T1 and T2 for determination of concentrations of TNF-α,IL-1,IL-6,IL-8 and IL-10.Results Compared with group C,airway peak pressure and airway plateau pressure were significandy decreased at T1 and T2,ling compliance was increased at T1 and T2,the concentrations of TNF-α,IL-1,IL-6 and IL-8 in BALF were decreased at T2,oxygenation index was increased and serum concentrations of TNF-α,IL-1,IL-6,IL-8 and IL-10 were decreased at T2-4 in group B (P ＜ 0.05).There was no significant difference in PaCO2 at each time point between the two groups (P ＞ 0.05).Conclusion Inhaled budesonide before operation can inhibit the inflammatory responses to OLV in patients undergoing thoracotomy,and is helpful in improving lung function.