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

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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

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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