氟比洛芬酯联合保护性机械通气对开胸手术患者的肺保护作用及对患者炎症因子、β-EP和PGE水平的影响

doi:10.3877/cma.j.issn.1674-6902.2019.01.016

目的

探究氟比洛芬酯联合保护性机械通气对开胸手术患者的肺保护作用及对患者炎症因子、β-内腓肽(β-EP)和前列腺素(PGE)水平的影响。

方法

选择2015年7月至2017年7月本院接受治疗的行开胸食管癌根治术的患者90例，根据随机数字法将其分为A、B、C三组，A组患者采用保护性机械通气治疗，B组患者采用氟比洛芬酯联合常规机械通气治疗，C组采用氟比洛芬酯联合保护性机械通气治疗。比较三组患者手术情况、PaO₂、PaO₂/FiO₂、肺功能异常情况、炎症因子以及β-EP、PGE水平。

结果

三组患者手术中机械通气时间、单肺通气时间、失血量、补液量以及手术时间比较无较大差异，具有统计学意义(P>0.05)。三组患者在治疗1、4 h后PaO₂水平增加，2、3、5 h后PaO₂水平降低；氧合指数(PaO₂/FiO₂)在治疗1、4 h后水平增加，2、3、5 h后水平降低。三组患者在治疗2 h之后PaO₂、PaO₂/FiO₂水平比较有较大差异，具有统计学意义(P<0.05)。三组患者治疗前未出现肺功能异常情况，术中均出现不同程度的肺功能异常情况，术后仅A、B两组患者出现肺功能异常现象。三组患者术后肺功能异常情况发生率比较有较大差异，具有统计学意义(P<0.05)。三组患者在治疗4 h后，TNF-α、IL-6、IL-8显著浓度增加，在治疗第5个h后TNF-α、IL-6、IL-8显著浓度降低。三组患者在治疗第4个h后，TNF-α、IL-6、IL-8浓度比较有较大差异，具有统计学意义(P<0.05)。三组患者β-EP、PGE水平在前三个h显著增加，在治疗第5个h后降低。治疗5 h后C组患者β-EP、PGE水平大于B组，B组水平大于A组，比较具有统计学意义(P<0.05)。

结论

开胸手术患者采用氟比洛芬酯联合保护性机械通气具有较好的肺保护作用，能够抑制炎性因子产生，值得临床推广使用。

关键词: 氟比洛芬酯, 保护性机械通气, 肺保护, 炎症因子

Objective

To investigate the protective effect of flurbiprofen axetil combined with protective mechanical ventilation on lung function and the levels of inflammatory factors, levels of beta-EP and PGE in patients undergoing thoracic surgery.

Methods

90 patients in July 2015 to July 2017 year in in our hospital for the treatment of open radical resection of thoracic esophageal cancer, according to randomly divided into A, B, C three groups, A group were treated with protective mechanical ventilation treatment, B group were treated with flurbiprofen axetil combined with conventional mechanical ventilation therapy, group C used flurbiprofen axetil combined protective mechanical ventilation. The operation, PaO₂, OI, lung function abnormalities, inflammatory factors, and levels of beta-EP and PGE were compared between the three groups.

Results

There was no significant difference in the time of mechanical ventilation, the time of single lung ventilation, the amount of blood loss, the volume of fluid infusion and the operation time between the three groups, and the difference was statistically significant (P>0.05). The level of PaO₂ increased in three groups after 1 and 4 hours, and the level of PaO₂ decreased after 2, 3 and 5 hours; the level of PaO₂/FiO₂ increased after 1 and 4 hours, and decreased after 2, 3 and 5 hours. After 2 hours treatment, the levels of PaO₂ and PaO₂/FiO₂ in the three groups were significantly different, with statistical significance (P<0.05). Three groups of patients did not appear before the treatment of abnormal pulmonary function, intraoperative varying degrees of abnormal pulmonary function, postoperative only A, B, two groups of patients with abnormal pulmonary function. The incidence of postoperative pulmonary dysfunction in the three groups was significantly different, with statistical significance (P<0.05). After 4 hours treatment, the concentrations of TNF-α, IL-6 and IL-8 increased in the three groups. After treatment for fifth hours, the concentrations of TNF-α, IL-6 and IL-8 decreased significantly. After fourth hours treatment, the concentrations of TNF-α, IL-6 and IL-8 in the three groups were significantly different, with statistical significance (P<0.05). The levels of beta-EP and PGE in the three groups increased significantly during the first three hours, but decreased after fifth hours. After 5 hours treatment, the levels of beta-EP and PGE in the C group were higher than those in the B group, and the level of B group was higher than that of the A group, and the difference was statistically significant (P<0.05).

Conclusions

Conclusion flurbiprofen axetil combined with protective mechanical ventilation has better lung protective effect and can inhibit the production of inflammatory factors in patients undergoing thoracic surgery. It is worthy of clinical use.

Key words: Flurbiprofen axetil, Protective mechanical ventilation, Lung protection, Inflammatory factors

表1 三组患者手术情况比较(±s)

组　别	例数	机械通气时间(min)	单肺通气时间(min)	失血量(ml)	补液量(ml)	手术时间(min)
A组	32	301.37±36.68	131.48±10.58	286.62±63.26	1927.47±268.75	277.36±12.15
B组	30	290.37±30.37	133.92±11.03	297.46±55.03	1893.73±271.38	277.47±18.36
C组	28	308.86±30.15	132.58±11.38	313.58±77.72	1953.37±256.79	276.47±17.94
F值	?	2.43	0.37	1.27	0.38	0.03
P值	?	0.0937	0.6917	0.2868	0.6850	0.9671

表1 三组患者手术情况比较(±s)

组　别	例数	机械通气时间(min)	单肺通气时间(min)	失血量(ml)	补液量(ml)	手术时间(min)
A组	32	301.37±36.68	131.48±10.58	286.62±63.26	1927.47±268.75	277.36±12.15
B组	30	290.37±30.37	133.92±11.03	297.46±55.03	1893.73±271.38	277.47±18.36
C组	28	308.86±30.15	132.58±11.38	313.58±77.72	1953.37±256.79	276.47±17.94
F值	?	2.43	0.37	1.27	0.38	0.03
P值	?	0.0937	0.6917	0.2868	0.6850	0.9671

表2 三组患者治疗前后PaO₂、PaO₂/FiO₂比较(±s)

指　标	组别	例数	T0	T1	T2	T3	T4	T5
PaO₂	A组	32	86.37±5.37	463.26±40.62	133.57±16.47	129.62±17.47	382.48±82.38	85.23±7.26
?	B组	30	88.68±6.47^b	487.26±45.26	143.36±12.47^a	142.47±12.26^a	450.26±76.37^a	91.26±6.26^a
?	C组	28	85.16±4.15	478.26±29.62	156.37±9.41^ab	157.26±10.41^ab	516.26±23.47^ab	96.36±7.57^ab
F值	?	?	3.27	2.91	25.64	30.53	30.58	18.72
P值	?	?	0.0426	0.0598	0.0000	0.0000	0.0000	0.0000
PaO₂/FiO₂	A组	32	411.36±23.26	462.36±40.47	133.46±16.47	129.36±17.37	382.37±82.42	297.37±22.42
?	B组	30	420.26±28.37	478.27±45.62	143.62±12.62^a	142.52±12.62^a	451.26±72.62^a	314.36±21.25^a
?	C组	28	405.26±18.52	478.25±30.01	151.26±10.31^ab	156.36±10.02^ab	517.36±23.51^ab	331.51±25.16^ab
F值	?	?	3.03	1.64	13.37	29.22	32.49	16.52
P值	?	?	0.0533	0.1996	0.0000	0.0000	0.0000	0.0000

表2 三组患者治疗前后PaO₂、PaO₂/FiO₂比较(±s)

指　标	组别	例数	T0	T1	T2	T3	T4	T5
PaO₂	A组	32	86.37±5.37	463.26±40.62	133.57±16.47	129.62±17.47	382.48±82.38	85.23±7.26
?	B组	30	88.68±6.47^b	487.26±45.26	143.36±12.47^a	142.47±12.26^a	450.26±76.37^a	91.26±6.26^a
?	C组	28	85.16±4.15	478.26±29.62	156.37±9.41^ab	157.26±10.41^ab	516.26±23.47^ab	96.36±7.57^ab
F值	?	?	3.27	2.91	25.64	30.53	30.58	18.72
P值	?	?	0.0426	0.0598	0.0000	0.0000	0.0000	0.0000
PaO₂/FiO₂	A组	32	411.36±23.26	462.36±40.47	133.46±16.47	129.36±17.37	382.37±82.42	297.37±22.42
?	B组	30	420.26±28.37	478.27±45.62	143.62±12.62^a	142.52±12.62^a	451.26±72.62^a	314.36±21.25^a
?	C组	28	405.26±18.52	478.25±30.01	151.26±10.31^ab	156.36±10.02^ab	517.36±23.51^ab	331.51±25.16^ab
F值	?	?	3.03	1.64	13.37	29.22	32.49	16.52
P值	?	?	0.0533	0.1996	0.0000	0.0000	0.0000	0.0000

表3 三组患者肺功能异常情况比较[n(%)]

组　别	例数	术前	术中	术后
A组	32	0	30(100)	9(30)
B组	30	0	30(100)	2(6.67)^a
C组	28	0	30(100)	0^a
χ²值	?	?	?	13.8780
P值	?	?	?	0.0010

表3 三组患者肺功能异常情况比较[n(%)]

组　别	例数	术前	术中	术后
A组	32	0	30(100)	9(30)
B组	30	0	30(100)	2(6.67)^a
C组	28	0	30(100)	0^a
χ²值	?	?	?	13.8780
P值	?	?	?	0.0010

表4 三组患者血清炎性因子浓度比较(±s)

指　标	组别	T0	T4	T5
TNF-α	A组	1.05±0.36	1.89±0.41	1.20±0.27
?	B组	0.97±0.28	1.40±0.43^a	1.05±0.20^a
?	C组	0.90±0.24	1.04±0.35^ab	0.89±0.15^ab
F值	?	1.91	34.45	15.97
P值	?	0.1544	0.0000	0.0000
IL-6	A组	132.36±24.26	236.36±50.26	170.26±25.48
?	B组	131.36±21.62	169.52±23.52^a	152.47±21.48^a
?	C组	130.36±22.26	169.36±20.15^a	152.36±21.36^ab
F值	?	0.06	38.55	6.10
P值	?	0.9437	0.0000	0.0033
IL-8	A组	195.36±17.37	832.36±43.47	596.37±44.26
?	B组	185.36±28.51	465.26±25.47^a	336.36±28.58^a
?	C组	186.37±20.14	438.26±20.41^ab	313.36±18.48^ab
F值	?	1.79	1 476.21	713.26
P值	?	0.1723	0.0000	0.0000

表4 三组患者血清炎性因子浓度比较(±s)

指　标	组别	T0	T4	T5
TNF-α	A组	1.05±0.36	1.89±0.41	1.20±0.27
?	B组	0.97±0.28	1.40±0.43^a	1.05±0.20^a
?	C组	0.90±0.24	1.04±0.35^ab	0.89±0.15^ab
F值	?	1.91	34.45	15.97
P值	?	0.1544	0.0000	0.0000
IL-6	A组	132.36±24.26	236.36±50.26	170.26±25.48
?	B组	131.36±21.62	169.52±23.52^a	152.47±21.48^a
?	C组	130.36±22.26	169.36±20.15^a	152.36±21.36^ab
F值	?	0.06	38.55	6.10
P值	?	0.9437	0.0000	0.0033
IL-8	A组	195.36±17.37	832.36±43.47	596.37±44.26
?	B组	185.36±28.51	465.26±25.47^a	336.36±28.58^a
?	C组	186.37±20.14	438.26±20.41^ab	313.36±18.48^ab
F值	?	1.79	1 476.21	713.26
P值	?	0.1723	0.0000	0.0000

表5 三组患者β-EP、PGE水平比较(±s)

指　标	组别	例数	T0	T1	T3	T5
β-EP	A组	32	144.26±45.25	145.36±50.37	175.26±30.36	129.44±23.04
?	B组	30	144.65±46.47	146.46±49.26	173.47±35.36	136.63±20.52
?	C组	28	144.62±46.15	148.48±48.15	160.62±44.62	145.65±21.62
F值	?	?	0.00	0.03	1.38	4.18
P值	?	?	0.9993	0.9695	0.2573	0.0184
PGE	A组	32	26.36±10.26	28.42±12.03	54.44±15.11	41.25±13.46
?	B组	30	25.26±8.37	27.27±11.62	50.22±14.56	35.25±13.32
?	C组	28	26.53±10.42	26.14±12.52	30.66±13.62	33.36±11.31
F值	?	?	0.15	0.27	23.15	3.14
P值	?	?	0.8604	0.7565	0.0000	0.0483

表5 三组患者β-EP、PGE水平比较(±s)

指　标	组别	例数	T0	T1	T3	T5
β-EP	A组	32	144.26±45.25	145.36±50.37	175.26±30.36	129.44±23.04
?	B组	30	144.65±46.47	146.46±49.26	173.47±35.36	136.63±20.52
?	C组	28	144.62±46.15	148.48±48.15	160.62±44.62	145.65±21.62
F值	?	?	0.00	0.03	1.38	4.18
P值	?	?	0.9993	0.9695	0.2573	0.0184
PGE	A组	32	26.36±10.26	28.42±12.03	54.44±15.11	41.25±13.46
?	B组	30	25.26±8.37	27.27±11.62	50.22±14.56	35.25±13.32
?	C组	28	26.53±10.42	26.14±12.52	30.66±13.62	33.36±11.31
F值	?	?	0.15	0.27	23.15	3.14
P值	?	?	0.8604	0.7565	0.0000	0.0483

1	李冰，黄宁，王志刚，等. 地佐辛联合氟比洛芬酯用于老年肿瘤患者开胸手术术后的镇痛效果[J]. 临床麻醉学杂志，2013, 29(10): 1007-1008.
2	李慧婷，钟忠健，刘文杰，等. 单肺通气导致的肺炎性损伤及姜黄素的干预作用[J]. 中山大学学报，2013, 34(05): 688-694.
3	谢华，刘美岑，宋迪，等. 呼吸内科1 531例住院患者机械通气情况调查分析[J]. 中国呼吸与危重监护杂志，2015, 14(06): 560-564.
4	Takada M,Taruishi C,Sudani T, et al. Intravenous Flurbiprofen Axetil Can Stabilize the Hemodynamic Instability Due to Mesenteric Traction Syndrome-Evaluation With Continuous Measurement of the Systemic Vascular Resistance Index Using a FloTrac^®，Sensor[J]. Journal of Cardiothoracic & Vascular Anesthesia, 2013, 27(4): 696-702.
5	Takahashi H,Shida D,Tagawa K, et al. Therapeutic effects of flurbiprofen axetil on mesenteric traction syndrome: randomized clinical trial[J]. BMC Surg, 2017, 17(1): 90.
6	Takahashi H,Shida D,Tagawa K, et al. Hemodynamics of mesenteric traction syndrome measured by FloTrac sensor[J]. J Clin Anesth, 2016, 30: 46-50.
7	Takahashi H,Shida D,Tagawa K, et al. The preventive effect of flurbiprofen on preventing mesenteric traction syndrome[J]. Masui, 2013, 62(3): 309-314.
8	Krohn PS,Ambrus R,Zaar M, et al. [Mesenteric traction syndrome][J]. Ugeskr Laeger, 2014, 176(8A): V09130546.
9	Zhang L,Zhu J,Xu L, et al. Efficacy and safety of flurbiprofen axetil in the prevention of pain on propofol injection: a systematic review and meta-analysis[J]. Med Sci Monit, 2014, 20: 995-1002.
10	岳萌，姚培宇，崔楚云，等. 机械通气患者早期活动效果的系统评价[J]. 中华护理杂志，2016, 51(05): 551-557.
11	齐凯，熊汉鹏，刘小雄，等. 不同剂量盐酸氨溴索对开胸手术围术期患者肺保护作用的影响[J]. 中国药房，2016, 27(18): 2479-2481.
12	Kodaka M,Tsukakoshi M,Miyao H, et al. The fentanyl concentration required for immobility under propofol anesthesia is reduced by pre-treatment with flurbiprofen axetil.[J]. Canadian Journal of Anaesthesia, 2013, 60(12): 1204-1211.
13	Liu Z,Lu H,He G, et al. Non-steroidal anti-inflammatory drugs reduce the stress response during sevoflurane anesthesia[J]. Acta Anaesthesiol Scand, 2012, 56(7): 890-895.
14	王琼华，方晏红，许斌兵，等. 氯胺酮联合地塞米松在食管癌开胸手术中对肺损伤的保护作用[J]. 中国药房，2015, 26(20): 2828-2831.
15	严伟民，姜虹，陈万涛. 氟比洛芬酯预处理减轻大鼠吸入性肺损伤[J]. 第二军医大学学报，2015, 36(11): 1180-1186.
16	刘霞，王甲汉，李志清，等. 保护性机械通气与传统机械通气治疗大面积烧伤合并重度吸入性损伤的效果比较[J]. 广东医学，2012, 33(14): 2155-2157.
17	Ohkawa T,Uchino T,Sasakura D, et al. Particle condition change in emulsion admixture evaluated by in situ flow particle imaging analysis.[J]. Chemical & Pharmaceutical Bulletin, 2013, 61(3): 333-339.
18	Oh DH,Balakrishnan P,Oh YK, et al. Effect of process parameters on nanoemulsion droplet size and distribution in SPG membrane emulsification[J]. Int J Pharm, 2011, 404(1-2): 191-197.
19	Tcholakova S,Denkov ND,Ivanov IB, et al. Coalescence stability of emulsions containing globular milk proteins[J]. Adv Colloid Interface Sci, 2006, 123-126: 259-293.
20	贺克强，柴小青，陈昆洲，等. 地佐辛复合氟比洛芬酯或芬太尼用于开胸手术术后镇痛的比较[J]. 临床麻醉学杂志，2012, 28(8): 749-751.
21	陆珠凤，葛圣金，薛张纲，等. 肺保护策略对胸外科手术患者每搏量变异度的影响[J]. 第二军医大学学报，2012, 33(12): 1329-1334.
22	李查兵，徐峰，王伟，等. 羟考酮或芬太尼联合氟比洛芬酯用于开胸术后静脉镇痛的效果[J]. 临床麻醉学杂志，2016, 32(12): 1183-1185.
23	贾慧，裴凌. 氟比洛芬酯临床镇痛效果和安全性的Meta分析[J]. 中国循证医学杂志，2011, 11(12): 1409-1418.
24	孙振涛，王宁，曹亚楠，等. 肢体远隔缺血预处理减轻单肺通气时患者的肺损伤[J]. 重庆医学，2017, 46(6): 764-766＋769.
25	陈建玲. 机械通气对肺动脉高压伴呼吸衰竭患者血浆脑钠肽水平的影响[J]. 中国现代医学杂志，2013, 23(7): 107-109.
26	杨庆，林财珠. 氟比洛芬酯对开胸手术患者围术期多模式镇痛的影响[J]. 临床麻醉学杂志，2013, 29(6): 610-611.

[1]	孙艺玮, 陈炜, 秦巍, 杜景辰, 孟昕, 周永军. 血管腔内介入治疗糖尿病足合并下肢动脉硬化闭塞症患者术后再狭窄与血清炎症因子的相关性[J]. 中华损伤与修复杂志(电子版), 2024, 19(01): 34-40.
[2]	陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[3]	杜贵伟, 陆勇, 成博, 贺薏, 梁爽. 钬激光碎石术术后联合坦索罗辛治疗对输尿管结石患者的影响分析[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 491-496.
[4]	张璇, 高杨, 房雅君, 姚艳玲. 保护性机械通气在肺癌胸腔镜肺段切除术中的临床应用[J]. 中华肺部疾病杂志(电子版), 2024, 17(04): 563-567.
[5]	陈向军, 王在强, 王博荣, 王莉, 方芳, 金发光, 王光辉. PM_2.5通过激活颗粒酶B/IL-18信号通路促进炎症因子表达[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 207-211.
[6]	方慧慧, 方明, 黄娟, 张华, 王晓娟. 布地格福吸入治疗对COPD患者IL-6、CRP水平及肺功能的影响[J]. 中华肺部疾病杂志(电子版), 2024, 17(01): 91-94.
[7]	方晓铵, 熊欢庆, 李玉娟, 刘刚, 金发光. E3泛素连接酶COP-1在脂多糖致小鼠急性肺损伤中的意义[J]. 中华肺部疾病杂志(电子版), 2024, 17(01): 14-18.
[8]	何花, 周玉皆, 李田. 鸦胆子油乳辅助PC方案化疗对NSCLC免疫功能和炎症因子的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(05): 697-699.
[9]	刘剑, 张燕, 刘春桂, 吉浩明, 鲁小敏. 贝伐珠单抗辅助治疗对晚期非鳞NSCLC患者炎症、免疫和营养指数的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(05): 694-696.
[10]	张婵, 吕瑶, 张小燕, 张鸣青. 不同时机局部神经阻滞在开腹肝切除中的镇痛效果比较[J]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 189-194.
[11]	史亚波, 李扬, 黄长文. 缺血-再灌注损伤促进肝癌复发机制的研究进展[J]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 96-99.
[12]	戴伟川, 郭协力, 方仲宁, 蔡文华, 洪天生, 田夏阳. 显微镜下周围神经松解术治疗腰椎间盘突出症术后残余神经症状的疗效分析[J]. 中华神经创伤外科电子杂志, 2024, 10(02): 84-90.
[13]	李秀玲, 连少锋, 荣刘涛, 李登峰, 饶蕴玉. 利巴韦林联合复方嗜酸乳杆菌治疗轮状病毒肠炎患儿的临床研究[J]. 中华消化病与影像杂志(电子版), 2024, 14(04): 369-372.
[14]	吕涛, 张琨, 李晨. 芍黄安肠汤治疗重度活动期溃疡性结肠炎大肠湿热证患者的疗效及对肠黏膜屏障、炎症因子和免疫功能的影响[J]. 中华消化病与影像杂志(电子版), 2024, 14(01): 16-20.
[15]	屈霄, 王靓, 陆萍, 何斌, 孙敏. 外周血炎症因子及肠道菌群特征与活动性溃疡性结肠炎患者病情的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 466-470.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Protective effect of flurbiprofen axetil combined with protective mechanical ventilation on lung function in patients undergoing thoracic surgery and the levels of inflammatory factors, levels of beta-EP and PGE in patients

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Protective effect of flurbiprofen axetil combined with protective mechanical ventilation on lung function in patients undergoing thoracic surgery and the levels of inflammatory factors, levels of beta-EP and PGE in patients