【摘要】 目的 探讨盐酸戊乙奎醚对肺癌根治术患者非通气侧肺损伤及内质网应激（ERS）的影响。方法 选取2016年1—8月于河南省胸科医院行肺癌根治术的患者80例。根据随机数字表法将所有患者分为盐酸戊乙奎醚预处理组（P组）和对照组（C组）,各40例。C组患者于麻醉诱导前10 min静脉注射等容量0.9%氯化钠注射液;P组患者于麻醉诱导前10 min静脉注射盐酸戊乙奎醚0.01 mg/kg。比较2组患者药物干预前（T₀）、单肺通气即刻（T₁）、单肺通气60 min时（T₂）、单肺通气结束即刻（T₃）、术毕（T₄）和术后24h（T₅）时动脉血氧分压（PaO₂）及动脉血二氧化碳分压（PaCO₂）水平、T₁和T₃时左下肺叶组织湿干重比和肺损伤评分、左下肺叶组织病理学改变情况和超微结构的改变情况、葡萄糖调节蛋白78（GRP78）和碱基序列（CCAAT）/增强子结合蛋白同源蛋白（CHOP）mRNA及其蛋白表达、血清肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）和IL-8水平。结果 2组患者T₁^T₄时PaO₂水平高于同组T₀时（均P<0.05）。T₂^T₄时,P组患者PaO₂水平高于C组（均P<0.05）。2组患者T₃时左下肺叶组织湿干重比及肺损伤评分均高于同组T₁时[C组:（6.76±0.27）比（4.02±0.15）、（2.2±0.8）分比（0.0±0.0）分;P组:（5.33±0.20）比（3.98±0.16）、（0.9±0.7）分比（0.0±0.0）分]（均P<0.05）。T₃时,P组患者左下肺叶组织湿干重比及肺损伤评分均低于C组（均P<0.05）。T₃时,C组患者肺组织病理学和超微结构改变比P组患者明显。2组患者T₃时左下肺叶组织GRP78和CHOP mRNA及其蛋白表达均高于T₁时（均P<0.05）。T₃时,P组患者左下肺叶组织GRP78和CHOP mRNA及其蛋白表达均低于C组（均P<0.05）。2组患者T₂^T₅时血清TNF-α、IL-6和IL-8水平均高于本组T₀时,差异均有统计学意义（均P<0.05）。P组患者T₂^T₅时血清TNF-α、IL-6和IL-8水平均低于C组（均P<0.05）。结论 盐酸戊乙奎醚可减轻肺癌根治术患者非通气侧肺损伤,其机制可能与其减轻ERS有关。更多还原

【Abstract】 Objective To explore the effect of penehyclidine hydrochloride on non-ventilated lung injury and endoplasmic reticulum stress（ERS） in patients with radical resection of pulmonary cancer. Methods Eighty patients undergoing radical surgery of pulmonary cancer from January to August 2016 in Henan Chest hospital were randomly divided into penehyclidine hydrochloride preconditioning group（group P） and control group（group C）,with 40 cases in each group. The group C had intravenous injection of 0. 9% sodium chloride solution and the group P had intravenous injection of 0. 01 mg/kg penehyclidine hydrochloride 10 min before anesthesia induction.Arterial partial pressure of oxygen（PaO₂） and arterial partial pressure of carbon dioxide（PaCO₂） were monitored before drug treatment（ T₀）, at the time of one lung ventilation（T₁）, 60 min after one lung ventilation（T₂）, at the end of one lung ventilation（T₃）, at the end of operation（T₄） and 24 h after operation（ T₅）. The wet to dry weight ratio of left lung lower lobe, score of lung injury, pathological and ultrastructural changes of left lung lower lobe,expressions of glucose regulated protein 78（GRP78） and nucleotide sequence（CCAAT）/enhancer-binding protein homologous protein（ CHOP） were recorded at T₁ and T₃. Serum levels of tumor necrosis factor-α（ TNF-α）,interleukin-6（IL-6） and IL-8 were detected. Results PaO₂ at T₁-T₄ were significantly higher than that at T₀ in both groups（P < 0. 05）. PaO₂ at T₂-T₄ in group P were significantly higher than those in group C（P < 0. 05）. The wet to dry weight ratio of left lung lower lobe and score of lung injury at T₃ were significantly higher than those at T₁ in both groups [ group C:（6. 76 ± 0. 27） vs（4. 02 ± 0. 15）,（2. 2± 0. 8） points vs（0. 0 ± 0. 0） points; group P:（5. 33 ±0. 20） vs（3. 98 ±0. 16）,（0. 9 ±0. 7）points vs（0. 0 ±0. 0） points]（P < 0. 05）. The wet to dry weight ratio of left lung lower lobe and score of lung injury at T3 in group P were significantly lower than those in group C（P < 0. 05）. Pathological and ultrastructural changes of left lung lower lobe in group P were more significant than those in group C. Expressions of GRP78 and CHOP mRNA and protein at T3 were significantly higher than those at T, in group P and group C（P <0. 05）. Expressions of GRP78 and CHOP mRNA and protein at T3 in group P were significantly lower than those in group C（ P < 0.05）. Levels of TNF-α, IL-6 and IL-8 at T₂-T₅ were higher than those at T₀ in both groups and there were significant differences between groups（P < 0. 05）. Conclusion Penehyclidine hydrochloride preconditioning can reduce damage on non-ventilated lung in patients undergoing radical surgery of lung cancer, the mechanism may be associated with its alleviation on ERS.更多还原