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目的研究乌司他丁对食管癌开胸手术患者机体应激反应的影响。方法32例择期食管癌手术患者随机分为对照组(16例)和治疗组(16例),治疗组于麻醉诱导后即将乌司他丁20万U持续静脉输注,之后每12h重复使用。麻醉诱导后20min(T1),诱导后90min(T2)及术后1、2、3d(T3～5)抽取静脉血测定并比较二组血清去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)、白介素-6(IL-6)、白介素-8(IL-8)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)以及丙二醛(MDA)和超氧化物歧化酶(SOD)浓度。结果二组患者NE、E、Cor、IL-6、IL-8、TNF-α、IL-10和MDA浓度在T2～4时高于T1(P<0.01),SOD浓度在T2～4时低于T1(P<0.01)。治疗组IL-6、IL-8、TNF-α以及MDA水平在T2～4时低于对照组(P<0.01),IL-10和SOD水平在T2～4时高于对照组(P<0.05或0.01)。结论食管癌开胸患者围术期使用乌司他丁可以抑制IL-6、IL-8、TNF-α等炎性因子的生成和释放,增加抑炎因子IL-10的表达,同时可以减轻机体的氧化损伤,但对去甲肾上腺素、肾上腺素以及皮质醇无明显影响。
Objective To investigate the effect of ulinastatin on the stress response in esophageal cancer patients undergoing thoracotomy. Methods Thirty-two patients undergoing elective esophageal cancer surgery were randomly divided into control group (n = 16) and treatment group (n = 16). The treatment group received continuous infusion of ulinastatin 200 000 U after induction of anesthesia and then repeated every 12 h. The venous blood samples were drawn at 20 min (T1), 90 min (T2) and 1,2,3 d (T3 ~ 5) after induction of anesthesia. The levels of serum norepinephrine, epinephrine, Cor, IL-6, IL-8, IL-10, TNF- And superoxide dismutase (SOD) concentrations. Results The concentrations of NE, E, Cor, IL-6, IL-8, TNF-α, IL-10 and MDA in T2DM group were higher than those in T1 group At T1 (P <0.01). The level of IL-6, IL-8, TNF-α and MDA in the treatment group were lower than those in the control group at T2 ~ 4 (P <0.01) Or 0.01). Conclusion Ulinastatin can inhibit the production and release of inflammatory factors such as IL-6, IL-8 and TNF-α during the perioperative period in patients with esophageal cancer thoracotomy and increase the expression of IL-10. At the same time, Of the oxidative damage, but no significant effect on norepinephrine, epinephrine and cortisol.