盐酸氨溴索对胸部外科手术rn致PS下降的保护作用

摘要

目的研究开胸手术致术侧肺损伤引起肺泡表面活性物质(PS)下降，及盐酸氨溴索(ambroxol)对此的保护作用。方法开左胸行食管癌根治主动脉弓上吻合术患者24例，随机分成实验组10例和对照组14例。实验组术前3天静脉给予盐酸氨溴索1 g。手术采用气管插管及硬膜外阻滞复合全身麻醉，手术前气管插管后及手术结束拔除气管插管前，分别做两侧支气管肺泡灌洗，测定灌洗液中总磷脂(TPL)、饱和卵磷脂(SatPC)和总蛋白(TP)量。取SatPC/TPL和SatPC/TP比值作为判断PS活性水平的指标。结果对照组中术侧肺手术后SatPC/TPC及SatPC/TP值明显低于术前(P<0.05)，非手术侧上述比值无明显差异。实验组中，手术前后SatPC/TPL和SatPC/TP，左右肺均无显著差异(P>0.05)。结论胸部外科手术可造成术侧肺PS下降和蛋白渗出增多。大剂量盐酸氨溴索能促进PS的合成和分泌，防止上述原因造成的PS下降。%Purpose　To investigate whether thoracotomy can induce lung injury in the operative side and the protection by ambroxol in this procedure.　Methods　24 patients with esophageal carcinoma who were performed esophagectomy with anastomosis over the arcus aortae were randomized into 2 groups:an ambroxol group (ambroxol 1 g iv gtt qd×3,preoperatively) and a controlled group without any respiratory medication.General anesthesia by tracheo-cannula combined with continuous epidual anesthesia were used in all the patients.Bilateral broncho-alveolar lavage(BAL) was carried out after intubation preoperatively and before removal of the cannula postoperatively.Total Phospholipid(TPL),Saturated Phosphaytidylcholine(SatPC) and Total protein(TP) in the BALF were measured.The ratio of SatPC/TPL and SatPC/TP represented the activity of PS.　Results　In the controlled group,SatPC/TPL and SatPC/TP of the left lung(operation side) showed significant difference(P<0.05),compared with the right side(non-operation side).In the ambroxol group,no significant difference of such ratio was showed.　Conclusions　Thoracotomy can induce lung injury and bring out the decrease of PS and increase of protein exudation in the operative side.Large dose of ambroxol can promote in synthesize and secretion of PS and protect those changes.