苦参素对胸腔镜术中单肺通气相关肺损伤的保护作用

摘要

Objective To investigate the protective effect of matrine on lung injury associated with single lung ventilation during thorac-ic surgery,and to explore and consummate the prevention and control measures of single lung ventilation related lung injury.Methods To-tally 97 cases of non small cell lung cancer patients were randomly divided into the observation group ( 50 cases ) and the control group (47 cases) .The two groups of patients were given the same way of anesthesia.Patients of the observation group received intravenous drip of 2 mL matrine injection which were dissolved in 100 mL saline solution 30 min before anesthesia, while patients of the control group were merely given 100 mL saline solution 30 min before anesthesia.The pulmonary shunt fraction( Qs/Qt) ,xanthine oxidase( XOD) ,myeloperoxi-dase(MPO),superoxide dismutase(SOD) and nitric oxide(NO) of the following points in time were compared:before anesthesia induction (T0),the instant of OLV (T1),60 minutes after OLV(T2),120 minutes after OLV(T3),after lung inflation (T4),and 24 hours after opera-tion ( T5) .Results At the time of T1 to T4,pulmonary shunt fraction of the two groups were both significantly higher than that at T0 with sig-nificant difference ( P<0.05) ,but there was no statistical difference in terms of intra-group comparison at different time points ( P>0.05) .The PMN counts of the two groups at the time of T2 to T5 were significantly higher than that of T0 with significant difference (P<0.05),and the PMN counts at the time of T2 to T5 in the control group were significantly higher than that in the observation group with significant difference (P<0.05).The levels of serum XOD,MPO,and SOD at T2 to T4 in both of the two groups were significantly higher than that at T0 with signif-icant difference (P<0.05),and the serum levels of XOD,MPO and SOD at T2 to T4 in the control group were significantly higher than those in the observation group with significant difference (P<0.05).The levels of serum NO at T2 to T4 in both of the two groups were significantly higher than that at T0 with significant difference (P<0.05),and it was significantly lower than that in the observation group with significant difference (P<0.05).Conclusion The matrine pretreatment of lung injury in the patients with single lung ventilation has a protective effect, which can reduce the levels of oxidative stress and promote the NO release in patients by reducing PMN,XOD and MPO levels.%目的：分析苦参素对胸腔镜术中单肺通气相关肺损伤的保护作用，探讨并完善单肺通气相关肺损伤的防治措施。方法将97例胸腔镜下肺癌根治术非小细胞肺癌患者按照随机数字表法分为观察组50例、对照组47例，2两组患者采取相同的麻醉方式，观察组在麻醉前30 min给予苦参素注射液2 mL溶于100 mL生理盐水中静脉注射，对照组患者于手术麻醉前30 min给予100 mL生理盐水静脉注射，比较2组患者麻醉诱导前（ T0）、OLV即刻（ T1）、OLV 60 min后（ T2）、OLV 120 min后（ T3）、膨肺后（T4）以及术后24 h（T5），各时间肺内分流率（Qs／Qt）、黄嘌呤氧化物（XOD）、髓过氧化物酶（MPO）、超氧化物歧化酶（SOD）及一氧化氮（NO）水平。结果2组患者T1～T4各时间点肺内分流率均较T0显著升高，差异具有统计学意义（P＜0．05），不同时间2组肺内分流率比较，差异无统计学意义（P＞0．05）；2组患者T2～T5血PMN计数均较T0显著升高，差异具有统计学意义（P＜0．05），且对照组T2～T5血PMN计数显著高于观察组，差异具有统计学意义（P＜0．05）；2组患者T2～T4血清XOD、MPO、SOD水平均较T0显著升高，差异具有统计学意义（P＜0．05），且对照组T2～T4血清XOD、MPO、SOD水平均显著高于观察组，差异具有统计学意义（P＜0．05）；T2～T4时间2组血清NO水平较T0显著升高，差异具有统计学意义（P＜0．05），且对照组T2～T4血清NO水平均显著低于观察组，差异具有统计学意义（P＜0．05）。结论苦参素预处理对胸腔镜术中单肺通气肺损伤具有一定的保护作用，其通过降低PMN、XOD以及MPO水平减少单肺通气患者的肺损伤，同时缓解机体单肺通气时的氧化应激水平，促进NO释放从而对肺组织起到保护作用。