| 摘要: |
| ［摘要］ 目的 探讨西维来司他钠对急性Stanford A型主动脉夹层(AAAD)手术患者围术期急性肺损伤(ALI)的影响。方法 招募2021年12月至2022年6月期间于河南省胸科医院手术室急诊行手术治疗的AAAD患者72例，采用随机数字表法将其分为西维来司他钠组(S组)和乌司他丁组(U组)，每组36例。S组患者于麻醉前10 min经静脉以0.2 mg/（kg·h）的速率泵注西维来司他钠注射液直至机械通气脱机。U组患者于麻醉前10 min以2万U/kg的剂量经静脉泵注乌司他丁直至机械通气结束脱机。于麻醉诱导后切皮前(T1)、术毕即刻(T2)、术后24 h(T3)及48 h(T4)时采集桡动脉血行血气分析，计算肺泡-动脉血氧分压差(PA-a DO2)、肺泡氧合指数(OI)和呼吸指数(RI)。于T1～T4时抽取中心静脉血测定肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和白细胞介素-8（IL-8）水平。于术前1 d及术后1 d、3 d时抽取外周静脉血并测定白细胞计数(WBC)、中性粒细胞计数(NEUT)和中性粒细胞百分比(NEUT%)及C反应蛋白(CRP)水平。记录患者术后肺部并发症(PPCs)发生率及不良反应发生率。结果 与U组比较，S组患者术后机械通气时间及ICU入住时间更短，差异有统计学意义(P<0.05)。在T2～T4时间点，S组PA-a DO2和RI水平显著低于U组（P<0.05），OI水平显著高于U组（P<0.05）；血清TNF-α、IL-6、IL-8水平均显著低于U组（P<0.05）。与术前1 d相比，两组术后1 d、3 d的WBC、NEUT、NEUT%及CRP水平均显著增高（P<0.05），S组水平低于U组（P<0.05）。S组术后高碳酸血症、低氧血症、新出现肺部啰音和支气管痉挛发生率均低于U组，差异有统计学意义(P<0.05)。结论 西维来司他钠可抑制AAAD手术患者炎性反应，减轻围术期ALI，降低PPCs发生率，改善患者早期预后。 |
| 关键词: 西维来司他钠 炎性反应 急性肺损伤 体外循环 急性Stanford A型主动脉夹层 |
| DOI：10.3969/j.issn.1674-3806.2023.09.08 |
| 分类号:R 614 |
| 基金项目:河南省科技攻关计划项目（编号：212102310720）；河南省医学科技攻关计划联合共建项目（编号：LHGJ20200216） |
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| An investigation of the effect of sivelestat sodium on perioperative acute lung injury in patients undergoing acute Stanford type A aortic dissection surgery |
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WU Guang-ling, LIU Si-qing, ZHOU Jun-hui, et al.
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Department of Anesthesiology, Henan Provincial Chest Hospital, Chest Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effect of sivelestat sodium on perioperative acute lung injury(ALI) in patients undergoing acute Stanford type A aortic dissection(AAAD) surgery. Methods Seventy-two patients with AAAD who underwent emergency surgical treatment in the Operating Room of Henan Provincial Chest Hospital from December 2021 to June 2022 were recruited and divided into sivelestat sodium group(group S) and ulinastatin group(group U) by random number table method, with 36 cases in each group. The patients in the group S were intravenously infused with sivelestat sodium injection via infusion pumps at a rate of 0.2 mg/(kg·h) 10 minutes before anesthesia until the mechanical ventilation was weaned off. The patients in the group U were given ulinastatin intravenously at a dose of 20 000 U/kg 10 minutes before anesthesia until the mechanical ventilation was ended and weaned off. The radial artery blood was collected for blood gas analysis before skin incision and after induction of anesthesia(T1), immediately after operation(T2), 24 hours(T3) and 48 hours(T4) after operation, and the alveolar-arterial oxygen partial pressure difference(PA-a DO2), alveolar oxygenation index(OI) and respiratory index(RI) were calculated. The central venous blood was drawn from T1 to T4 time points to determine the levels of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and interleukin-8(IL-8). The peripheral venous blood was drawn 1 day before operation, and 1 day and 3 days after operation, and white blood cell count(WBC), neutrophil count(NEUT), neutrophil percentage(NEUT%) and the level of C-reactive protein(CRP) were determined. The patients′ incidence rates of postoperative pulmonary complications(PPCs) and adverse reactions were recorded. Results Compared with those in the group U, the patients in the group S had shorter postoperative mechanical ventilation time and intensive care unit(ICU) stay time, and the difference was statistically significant(P<0.05). At the T2 to T4 time points, the levels of PA-a DO2 and RI in the group S were significantly lower than those in the group U(P<0.05), and the level of OI in the group S was significantly higher than that in the group U(P<0.05), and the serum levels of TNF-α, IL-6 and IL-8 in the group S were significantly lower than those in the group U(P<0.05). Compared with those 1 day before surgery, the levels of WBC, NEUT, NEUT% and CRP in the two groups were significantly increased 1 day and 3 days after operation(P<0.05), and the levels in the group S were lower than those in the group U(P<0.05). The incidence rates of hypercapnia, hypoxemia, newly emerging pulmonary rales and bronchospasm in the group S were lower than those in the group U after operation, and the differences were statistically significant(P<0.05). Conclusion Sivelestat sodium can inhibit the inflammatory response in patients undergoing AAAD surgery, and reduce perioperative ALI, and lower the incidence of PPCs, and improve the early prognosis of the patients. |
| Key words: Sivelestat sodium Inflammatory response Acute lung injury(ALI) Cardiopulmonary bypass Acute Stanford type A aortic dissection(AAAD) |
