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摘要：
目的 研究富马酸氯马斯汀对食管癌患者单肺通气时（one‑lung ventilation, OLV）的肺保护作用。 方法 选择拟行食管癌根治术的患者60例，采用随机数字表法将患者分为两组（每组30例）：富马酸氯马斯汀组（F组）和对照组（C组）。F组患者于手术开始即刻肌内注射富马酸氯马斯汀2 mg（2 ml），C组患者于相同时刻肌内注射等容量生理盐水。记录两组患者麻醉诱导前（T0）、手术开始即刻（T1）、OLV 30 min（T2）、OLV 90 min（T3）、手术结束时（T4）的心率和MAP，于上述时间点取桡动脉血行血气分析，记录PaO2和PaCO2，计算氧合指数（oxygenation index, OI）、呼吸指数（respiratory index, RI）、肺泡动脉氧分压差（alveolar ‑arterial oxygen partial pressure difference, P（A‑a）O2）。记录T1~T4时的潮气量（tidal volume, VT）及气道峰压（peak airway pressure, Ppeak），计算动态肺顺应性（dynamic lung compliance, Cdyn）。分别取T0~T4时点的中心静脉血，检测血样中TNF‑α、IL‑6及组胺的浓度。记录术后住院时间及肺部并发症发生情况。 结果 与T0时比较：T1~T3时F组心率升高，T1~T4时C组心率升高，T1~T4时两组MAP降低（P<0.05）；T1时两组OI升高，T2~T4时OI降低，T1~T4时两组P（A‑a）O2、RI升高（P<0.05）；T2~T4时两组TNF‑α、IL‑6及组胺浓度升高（P<0.05）。与T1时比较，T2~T4时两组Cdyn降低（P<0.05）。与C组比较：T2~T4时F组心率降低，MAP、Cdyn升高（P<0.05）；T3、T4时F组P（A‑a）O2、RI降低，OI升高（P<0.05）；T2~T4 时F组TNF‑α、IL‑6、组胺浓度降低（P<0.05）；F组患者术后住院时间缩短，支气管痉挛、低氧血症、肺部炎症等肺部并发症发生率降低（P<0.05）。 结论 富马酸氯马斯汀可抑制炎性反应、减少组胺释放、改善肺功能、缩短术后住院时间及降低术后肺部并发症发生率，为围手术期肺保护提供一种新选择。
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Abstract: Objective To investigate the pulmonary protective effects of clemastine fumarate on patients with esophageal cancer during one‑lung ventilation (OLV). Methods Sixty patients who were scheduled for radical resection of esophageal cancer were selected. They were divided into two groups according to the random number table method (n=30): a clemastine fumarate group (group F) and a control group (group C). Patients in group F were intramuscularly injected with 2 mg (2 ml) of clemastine fumarate immediately after the operation, while those in group C were intramuscularly injected with the same volume of normal saline. Then, heart rate and mean arterial pressure (MAP) were recorded before anesthesia induction (T0), at the beginning of operation (T1), after OLV for 30 min (T2) and 90 min (T3), and at the end of the operation (T4). The radial artery blood samples were collected at the above time points for blood gas analysis. The arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded, while oxygen index (OI), respiratory index (RI) and alveolar⁃arterial oxygen partial pressure difference [P（A‑a）O2] were calculated. The tidal volume (VT) and peak airway pressure (Ppeak) at T1, T2, T3 and T4 were recorded and the dynamic lung compliance (Cdyn) was calculated. The central venous blood samples were collected at T0, T1, T2, T3 and T4 to detect the concentrations of tumor necrosis factor‑α (TNF‑α), interleukin 6 (IL‑6) and histamine. The length of stay and pulmonary complications were recorded. Results Compared with those at T0, increased heart rate was found in group F at T1‒T3 and in group C at T1‒T4, while decreased MAP was observed in both groups at T1‒T4 (P<0.05). OI increased in both groups at T1 but decreased at T2‒T4, while P（A‑a）O2 and RI increased in both groups at T1‒T4 (P<0.05). The levels of TNF‑α, IL‑6 and histamine increased in both groups at T2‒T4 (P<0.05). Compared with those at T1, Cdyn decreased in both groups at T2‒T4 (P<0.05). Compared with group C, decreased heart rate and increased MAP and Cdyn were observed in group F at T2‒T4 (P<0.05); decreased P（A‑a）O2 and RI and increased OI were observed in group F at T3 and T4 (P<0.05), and reduced levels of TNF‑α, IL‑6 and histamine were observed in group F at T2‒T4 (P<0.05). Compared with group C, group F also showed shortened length of stay, with a declined incidence of pulmonary complications such as bronchospasm, hypoxemia and pulmonary inflammation (P<0.05). Conclusions Clemastine fumarate can inhibit the inflammatory response, reduce histamine release, improve pulmonary function, shorten the length of stay and reduce the incidence of postoperative pulmonary complications, providing a new option for perioperative pulmonary protection.
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