乌司他丁对老年患者下肢手术肺换气功能的影响

目的探讨乌司他丁对老年患者下肢手术肺换气功能的影响。方法选择老年单侧下肢手术患者（需要上止血带）35例．按单盲法随机分为对照组（C组,n=17）和乌司他丁组（U组,n=18）。行L2.3间隙脊椎．硬膜外联合阻滞,U组在上止血带前15min静脉滴注乌司他丁30万单位,C组以等量生理盐水于相同时间静脉注射。动态观察两组T0患者上止血带前（T0）、松止血带后2h（T1）、6h（T2）、24h（T3）4个时点血气指标及血丙二醛（MDA）和内皮素-1（ET-1）的浓度变化。结果与T0时比较,C组T2时动脉血氧分压（PaO2）降低,肺泡．动脉血氧分压差（PA-aDO2）和呼吸指数（RI）升高,Th3时血ET-1和MDA浓度升高（P〈0．05）。U组各时点血气指标及血MDA和ET-1的浓度变化比较差异无统计学意义（P〉0．05）;与C组比较,U组松止血带后的PaO2升高,PA-aDO2和RI下降,MDA和ET-1浓度降低（P〈0．05）。结论乌司他丁对老年患者下肢手术松止血带后的肺换气功能障碍有改善作用,其机制可能与其抑制氧自由基脂质过氧化和保护内皮细胞有关。

Effect of ulinastatin on pulmonary gas exchange in elderly patients undergoing lower extremity surgery

OBJECTIVE To investigate the effect of ulinastatin on pulmonary gas exchange in elderly patients undergoing unilateral lower extremity surgery. METHODS Thirty-five patients scheduled for unilateral lower extremity surgery were randomLy divided into 2 groups：control group（group C, n = 17）and experimental group （group U, n= 18）. All the patients agreed to a combined spinal-epidural anesthesia at the L2-L3 interspace and a radial artery catheter was placed for sampling. Ulinastatin 300,000U was intravenously dripped 15 min beforetourniquet inflation, The same volume of saline was given at the same time point s in group C.Blood samples which were used for blood gas analysis and measurement of malondialdehyde（MDA）and endothelin-1 （ET-1）were taken before tourniquet inflation and 2, 6, 24 hours after tourniquet deflation. Results Compared with the baseline values at To, in group C PaOz at T2 was significantly decreased, while PAa-DO2 and RI at T2 and the levels of MDA and ET-1 at TI-3 were significantly increased（P 〈 0.05） .And in group U, blood gas index, MDA and ET-1 did not produce significant changes after tourniquet deflation（P 〉0.05）. Compared with group C, the PaO2 was increased, the changes of PA-aDO2, RI, MDA and ET-1 were significantly mitigated in group U （ P 〈 0.05） . CONCLUSION Pulmonary gas exchange impairment induced by tourniquet application could be attenuated by ulinastatin therapy based on inhibiting lipid peroxidation and protecting endothelial cells.