国际麻醉学与复苏杂志   2019, Issue (7): 0-0
    
依达拉奉联合氟比洛芬酯对单肺通气患者肿瘤坏死因子-α和白细胞介素-6的影响
白洁, 马磊, 李思远, 张蓬勃, 张媛媛1()
1.西安交通大学第二附属医院
Effects of edaravone combined with flurbiprofen axetil on tumor necrosis factor-α and interleukin-6 of patients under one-lung ventilation
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摘要：

目的　观察依达拉奉和氟比洛芬酯对单肺通气（one-lung ventilation， OLV）患者肺部炎性因子TNF-α及血清IL-6水平的影响。　方法　择期行开胸肺叶切除/食管癌根治术患者60例， 采用随机数字表法分为4组：依达拉奉组（E组）、氟比洛芬酯组（F组）、依达拉奉联合氟比洛芬酯组（E+F组）以及生理盐水组（C组），每组15例。患者进行常规全身麻醉诱导及麻醉维持，经口置入一次性使用双腔支气管插管，在气管插管后10 min内，给予E组依达拉奉0.8 mg/kg、F组氟比洛芬酯1 mg/kg、E+F组依达拉奉0.8 mg/kg+氟比洛芬酯1 mg/kg加入生理盐水共计100 ml静脉滴注； C组静脉滴注生理盐水100 ml。记录围手术期血流动力学及血气指标。在气管插管后即刻（T1）与OLV 60 min （T2）收集通气侧肺支气管肺泡灌洗液（broncho-alveolar lavage fluid, BALF），同时在T1、T2时点经桡动脉采血5 ml，采用ELISA法测定BALF中TNF-α和血清中IL-6的浓度。　结果　与T1比较，T2时各组PaO2均降低（P<0.05），同一时点各组间PaO2差异无统计学意义（P>0.05）。与T1比较，E组、E+F组T2时BALF中TNF-α水平明显降低（P<0.05），而C组明显升高（P<0.05）； T2时，E组、F组、E+F组BALF中 TNF-α浓度均低于C组（P<0.05），而E组、F组、E+F组之间差异无统计学意义（P>0.05）。C组T2时血清IL-6水平均比T1时增高（P<0.05）；T2时，E组、F组及E+F组血清IL-6水平比C组低（P<0.05），而E组、F组、E+F组之间差异无统计学意义（P>0.05）。　结论　OLV增加手术患者肺组织局部及系统性的炎性反应。依达拉奉与氟比洛芬脂均可降低或抑制患者BALF中TNF-α和血清中IL-6的水平，减轻炎性反应，可用于OLV时的肺保护，但联合用药无明显优势。
关键词： 依达拉奉；　氟比洛芬酯；　单肺通气；　肿瘤坏死因子-α；　白细胞介素-6
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To observe the effects of edaravone combined with flurbiprofen axetil on the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in patients under one-lung ventilation (OLV).　Methods　A total of sixty patients undergoing thoracic surgery or radical resection for esophageal cancer were enrolled in this study. They were randomly divided into four groups (n=15): an edaravone group (group E), a flurbiprofen axetil group (group F), an edaravone combined with flurbiprofen axetil group (group E+F) and a normal saline group (group C). Patients underwent routine general anesthesia induction and maintenance. Then, 10 min after insertion of a double lumen endobronchial tube, group E was treated with 0.8 mg/kg edavarone, group F was treated with 1 mg/kg flurbiprofen axetil, group E+F was treated with 0.8 mg/kg edavarone and 1 mg/kg flurbiprofen axetil, and group C received 100 ml normal saline alone. Perioperavtive hemodynamics and blood gas indicators were recorded. The broncho?蛳alveolar lavage fluid (BALF) of the ventilated lung and radial arterial blood samples (5 ml) were collected at two time points: after intubation (T1) and 60 min after OLV (T2). The concentrations of TNF-α in BALF and serum IL-6 were determined by ELISA.　Results　The partial pressure of oxygen in arterial blood (PaO2) was significantly decreased at T2 in all groups, compare with those at T1 (P<0.05). The TNF-α concentration in BALF was significantly decreased in groups E and E+F (P<0.05), but remarkably increased in group C at T2, compare with those at T1 (P<0.05). Compared with group C, groups E, F and E+F showed remarkably decreased levels of TNF-α at T2 (P<0.05). The concentration of IL-6 in group C at T2 were higher than that at T1 (P<0.05). Compared with group C, groups E, F and E+F showed remarkably decreased levels of IL-6 at T2 (P<0.05).　Conclusions　OLV can induce lung and systemic inflammatory response. Edaravone and flurbiprofen axetil can decrease the levels of TNF-α in BALF and serum IL-6 to inhibit inflammatory response in patients undergoing surgery with OLV, where no apparent advantage was found in combined use.
Key words: Edaravone;　Flurbiprofen axetil;　One-lung ventilation;　Tumor necrosis factor-α;　Interleukin-6