奥曲肽对肝叶切除术患者围术期肺功能及炎性介质的影响.doc

网络出版时间：2014-02-19 11:12 网络出版地址：/kcms/detail/51.1095.R1112.002.html 奥曲肽对肝叶切除术患者围术期肺功能及炎性介质的影响 查兴盛1，2，陈 林2，陈 杨2，张 喆3（650021 昆明，云南省第二人民医院麻醉手术科1； 400038 重庆，第三军医大学；西南医院手术麻醉科2； 100086 北京，北京大学第三医院心脏外科3） [摘要] 目的 观察奥曲肽对肝叶切除术患者围术期血浆肿瘤坏死因子-α（tumour necrosis factor alpha，TNF-α）、白细胞介素-6（interleukin 6，IL-6）、肺表面活性物质相关蛋白D(surfactant protein D，SP-D)、氧合指数（oxygenation index，OI）和呼吸指数 (respiratory index，RI)的影响，探讨奥曲肽对肝癌患者肝叶切 除术围术期肺损伤的保护效应及可能机制。方法 选择2013 年2－12 月于西南医院肝胆外科择期行肝叶切除术的肝癌患者40 例，ASAⅡ～Ⅲ级，随机分为对照组或奥曲肽组，每组20 例。2 组患者均采用相同的麻醉方法。奥曲肽组在麻醉诱导后静脉注射奥曲肽0.1 mg，然后0.5 mg 溶于60 mL 氯化钠注射液中泵注至手术结束前30 min 停止；对照组予等容量氯化钠注射液泵注。监测并对比分析麻醉诱导前（T0）、切皮后10 min （T1）、 解除阻断恢复肝血流后30 min （T2）、术后1 h（T3）、术后24 h（T4）桡动脉血血气分析结果, 计算OI 值和RI 值; 于T0、T1、T2、T4 时检测TNF-α、IL-6 和SP-D 浓度。结果 两组组内各时相点与麻醉诱导前（T0）相比，T2～T4 时两组TNF-α、IL-6、SP-D 的含量和RI 值均显著升高（P0.05）；而OI 值显著降低 (P0.05)。两组组间各时相点同时值比较，T2～T4 三个时相点奥曲肽组TNF-α、IL-6、SP-D 的含量和RI 值均低于对照组，而OI 值高于对照组，均有显著差异（P0.05）。结论 奥曲肽能够抑制肝叶切除术患者围术期炎性反应，减轻肺损伤，并由此降低手术对肺功能的影响。 [关键词]奥曲肽；肺功能；炎症；肝叶切除术 Effects of octreotide on peri-operative pulmonary function and inflammatory response in patients undergoing hepalobectomy Zha Xingsheng1.2, Chen Lin2, Chen Yang2, Zhang Zhe3 (1Department of Anesthesiology, Yunnan Provincial SecondPeople’s Hospital, Kunming. Yunan Province, 650052; 2Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038; 3Department of Cardiovascular Surgery, Peking University ThirdHospital, Beijing, 100191, China) [Abstract] Objective To investigate the effects of octreotide on tumour necrosis factor alpha (TNF-α),interleukin 6 (IL-6), surfactant protein D (SP-D), oxygenation index (OI) and respiratory index (RI) in patients during peri-operative period of hepalobectomy. Methods Forty ASA Ⅱ or Ⅲ patients scheduled forhepalobectomy in Southwest hospital from February to December 2013 were enrolled in this study. Then they were randomly divided into octreotide group and control (n=20). The same standard anesthesia protocol was used fo