Effects of dexmedetomidine combined with ulinastatin on postoperative pulmonary function in elderly patients with acute abdomen / 中国现代普通外科进展

ABSTRACT

Objective:To observe whether intraoperative application of Dexmedetomidine combined with Ulinastatin has protective effect on postoperative pulmonary function in elderly patients with acute abdomen.Methods:80 cases of elderly patients with acute abdomen were divided into 4 groups randomlyControl group (group C);Dexmedetomidine group (group D);Ulinastatin group (group U) and Dexmedetomidine combined with Ulinastatin group (group D+U),20 cases in each group.In group D,before induction of anesthesia,a loading dose of Dexmedetomidine 1.0 μ g/kg was infused over 10 min,followed by continuous infusion of Dexmedetomidine at a rate of 0.5 μ g/ (kg·h) until the last 0.5 h before the end of surgery.Group U received Ulinastatin 10000 U/kg after induction of anesthesia.The patients in group D+U group were treated with the above two methods;and the patients in group C were given normal saline as control.General anesthesia was used in each group.Arterial blood gas analysis,oxygenation index,serum TNF-α and IL-8 levels were observed in all patients in preoperative 1 d and postoperative 1,3 and 5 d.All patients were back to ICU with intubation after operation.The duration of intubation,ICU treatment days,total hospitalization period and postoperative pulmonary complications were recorded.Results:For the oxygenation index,there was no significant difference between each group at TO (P＞0.05).But at T1,T2 or T3,the oxygenation index in group D+U is better than group D,group U or group C (P＜0.05).The comparison of serum TNF-α and IL-8 concentration in each group was almost the same as the oxygenation index.As for Duration of intubation,ICU treatment days,total hospitalization period,those in Group D+U are shorter than in other three groups (P＜0.05).In the incidence of postoperative pulmonary complications (atelectasis,pulmonary infection,etc),group D+U (18％) was significantly lower than C group(26％),group D(32％) and U group(38％,P＜0.05).Conclusion:The combination of dexmedetomidine and ulinastatin in elderly patients with acute abdomen can reduce the perioperative inflammatory response and improve the postoperative lung function.