Objective:To observe whether intraoperative application of Dexmedetomidine combined with Ulinastatin has protective effect on postoperative pulmonary function in elderly patients with acute abdomen.Methods:80 cases of elderly patients with acute abdomen were divided into 4 groups randomly:Control group (group C);Dexmedetomidine group (group D);Ulinastatin group (group U) and Dexmedetomidine combined with Ulinastatin group (group D+U),20 cases in each group.In group D,before induction of anesthesia,a loading dose of Dexmedetomidine 1.0 μ g/kg was infused over 10 min,followed by continuous infusion of Dexmedetomidine at a rate of 0.5 μ g/ (kg·h) until the last 0.5 h before the end of surgery.Group U received Ulinastatin 10000 U/kg after induction of anesthesia.The patients in group D+U group were treated with the above two methods;and the patients in group C were given normal saline as control.General anesthesia was used in each group.Arterial blood gas analysis,oxygenation index,serum TNF-α and IL-8 levels were observed in all patients in preoperative 1 d and postoperative 1,3 and 5 d.All patients were back to ICU with intubation after operation.The duration of intubation,ICU treatment days,total hospitalization period and postoperative pulmonary complications were recorded.Results:For the oxygenation index,there was no significant difference between each group at TO (P＞0.05).But at T1,T2 or T3,the oxygenation index in group D+U is better than group D,group U or group C (P＜0.05).The comparison of serum TNF-α and IL-8 concentration in each group was almost the same as the oxygenation index.As for Duration of intubation,ICU treatment days,total hospitalization period,those in Group D+U are shorter than in other three groups (P＜0.05).In the incidence of postoperative pulmonary complications (atelectasis,pulmonary infection,etc),group D+U (18％) was significantly lower than C group(26％),group D(32％) and U group(38％,P＜0.05).Conclusion:The combination of dexmedetomidine and ulinastatin in elderly patients with acute abdomen can reduce the perioperative inflammatory response and improve the postoperative lung function.%目的:观察术中应用右美托咪定复合乌司他丁对老年急腹症患者术后肺功能的影响.方法:选择山东省立医院收治的老年急腹症患者急症手术80例,分为4组:对照组(C组)、右美托咪定组(D组)、乌司他丁组(U组)和右美托咪定复合乌司他丁组(D+U组),所有患者分别于术前1d,术后1、3及5d行动脉血气分析,计算氧合指数,并测定血清TNF-α和IL-8的浓度.记录术后拔管时间,ICU带管时间、ICU治疗天数、总的住院时间及术后肺部并发症及死亡率.结果:(1)TO时4组氧合指数差异无统计学意义(P＞0.05),而T1、T2和T3时,D+U组较D组、U组及C组,明显升高(P＜0.05),D组和U组较C组升高(P＜0.05);(2)血清TNF-α及IL-8的浓度,TO时4组间差异无统计学意义(P＞0.05),而T1时,D+U组较D组、U组及C组明显升高(P＜0.05),D组和U组也高于C组(P＜0.05).T2时D+U组较D组、U组及C组,明显升高(P＜0.05),U组低于C组(P＜0.05);(3)术后带管时间,ICU治疗时间和住院天数,D+U组较D组、U组及C组,明显缩短(P＜0.05),而D组和U组较C组也减少(P＜0.05).术后肺部并发症(肺不张,肺感染等)D+U组(18％)低于C组(26％)、D组(32％),U组(38％,P＜0.05).结论:老年急腹症患者术中联合应用右美托咪定和乌司他丁可减轻术后炎症反应,对术后肺功能有保护作用.
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