CAJ | 학술논문

目的：观察消化道肿瘤手术麻醉诱导前静脉滴注乌司他丁对术后炎性介质与细胞免疫功能的影响。方法选取2012年10月至2014年9月行消化道肿瘤根治性手术的90例患者，据随机数字表法分为乌司他丁组(47例)与对照组(43例)，乌司他丁组麻醉诱导前静脉滴注乌司他丁2.5 kU / kg，对照组静脉滴注0.5%葡萄糖氯化钠注射液，术后进行常规抗感染、肠外营养支持处理，比较两组患者术前24 h 及术后12，24，48 h 血清炎性因子水平及外周血 T 细胞亚群变化情况。结果乌司他丁组术后12，24，48 h 白细胞介素（IL）－6及 IL －8、肿瘤坏死因子（TNF －α）炎性介质水平均低于对照组（ P ﹤0.05）；乌司他丁组术后12，24 h IL －10水平高于对照组，术后12 h 差异有统计学意义（ P ﹤0.05）；术后48 h 两组炎性介质水平差异无统计学意义（ P ﹥0.05）。乌司他丁组术后各观察时点CD3＋百分率均略高于对照组( P ﹥0.05)；术后12，24 h CD4＋百分率、CD4＋ / CD8＋均明显高于对照组（ P ﹤0.05），同时点 CD8＋百分率均明显低于对照组（ P ﹤0.05）；术后48 h，两组 T 细胞亚群指标差异均无统计学意义( P ﹥0.05)。结论乌司他丁能有效降低手术后早期炎性介质水平，改善应激状态时的细胞免疫功能，消化道肿瘤术前静脉滴注乌司他丁能在一定程度上减轻手术创伤造成的组织器官功能损害。
목적：관찰소화도종류수술마취유도전정맥적주오사타정대술후염성개질여세포면역공능적영향。방법선취2012년10월지2014년9월행소화도종류근치성수술적90례환자，거수궤수자표법분위오사타정조(47례)여대조조(43례)，오사타정조마취유도전정맥적주오사타정2.5 kU / kg，대조조정맥적주0.5%포도당록화납주사액，술후진행상규항감염、장외영양지지처리，비교량조환자술전24 h 급술후12，24，48 h 혈청염성인자수평급외주혈 T 세포아군변화정황。결과오사타정조술후12，24，48 h 백세포개소（IL）－6급 IL －8、종류배사인자（TNF －α）염성개질수평균저우대조조（ P ﹤0.05）；오사타정조술후12，24 h IL －10수평고우대조조，술후12 h 차이유통계학의의（ P ﹤0.05）；술후48 h 량조염성개질수평차이무통계학의의（ P ﹥0.05）。오사타정조술후각관찰시점CD3＋백분솔균략고우대조조( P ﹥0.05)；술후12，24 h CD4＋백분솔、CD4＋ / CD8＋균명현고우대조조（ P ﹤0.05），동시점 CD8＋백분솔균명현저우대조조（ P ﹤0.05）；술후48 h，량조 T 세포아군지표차이균무통계학의의( P ﹥0.05)。결론오사타정능유효강저수술후조기염성개질수평，개선응격상태시적세포면역공능，소화도종류술전정맥적주오사타정능재일정정도상감경수술창상조성적조직기관공능손해。
Objective To observe and investigate the influence of intravenous drip of ulinastatin before anesthesia induction in digestive tract tumor surgery on postoperative inflammatory mediators and cell immune function. Methods 90 cases of digestive tract tumor un-dergoing radical operation in our hospital from October 2012 to September 2014 were selected as the research subjects and randomized into the ulinastatin group(47 cases) and the control group(43 cases) according to the random number table. The ulinastatin group was intravenously dripped with ulinastatin 2. 5 kU / kg before anesthesia induction, while the control group with 0. 5% glucose and sodium chloride solution. The conventional anti - infection treatment and parenteral nutrition support were employed after operation. The changes of serum inflammatory factors and peripheral blood T cell subsets at preoperative 24 h and at postoperative 12, 24, 48 h were compared between the two groups. Results The IL - 6, IL - 8, TNF - α levels at postoperative 12 , 24 , 48 h in the ulinastatin group were lower than those in control group, the IL - 6, IL - 8, TNF - α levels at postoperative12 , 24 h had statistical differences between the two groups ( P ﹤ 0. 05 ); the IL - 10 level at postoperative 12, 24 h in the ulinastatin group was higher than those in the control group, the differ-ence at postoperative 12 h was statistically significant( P ﹤ 0. 05); there were no statistically significant differences in inflammatory me-diators at postoperative 48 h between 2 groups( P ﹥ 0. 05) . CD3 +% at each observation point in the ulinastatin group was slightly higher than that in the control group( P ﹥ 0. 05), CD4 +% , CD4 + / CD8 + at postoperative12, 24 h in the ulinastatin group were signifi-cantly higher than those in the control group( P ﹤ 0. 05), however, CD8 +% at the same time point was significantly lower than that in the control group( P ﹤ 0. 05). The T cell subsets at postoperative 48 h had no statistically significant difference between 2 groups( P ﹥0. 05) . Conclusion Ulinastatin can effectively reduce the early inflammatory mediator levels after surgery and improve the cellular im-mune function in stress state. Preoperative intravenous drip of ulinastatin in digestive tract tumor can alleviate tissue and organ function damage caused by surgical trauma in some degree.