Protective effects of ulinastatin on the lungs in patients with lung cancer undergoing lobectomy

Abstract

Objective To investigate the protective effects of ulinastatn on the lungs in patients with lung cancer undergoing lobectomy. Methods Forty ASA Ⅱ or Ⅲ patients with stage Ⅲ lung cancer, aged 50-64 yr weighing 53-70 kg undergoing lobectomy were randomly divided into 2 groups ( n = 20 each): control group (group C) and ulinastatin group (group U). In group U ulinastatin 10 000 U/kg in 20 ml normal saline was infused iv over 30 min immediately after induction of anesthesia. The patients were premedicated with diazepam 10 mg and scopolamine 0.3 mg im. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 4 μg/kg, TCI of propofol (Cp 4 μg/ml) and vecuronium 0.12 mg/kg and maintained with TCI of propofol (Cp 2-3 μg/ml) and intermittent iv boluses of fentanyl and vecuronium. The patients were intubated with double-lumen tube. Correct position of the tube was checked with fiberoptic bronchoscope. One-lung ventilation (OLV) was performed (VT 6-8 ml/kg, RR 10-16 bpm, I:R 1:2, FiO2 100% ). PETCO2 was maintained at 35-45 mm Hg. Arterial blood samples were taken before anesthesia (T0, baseline), at 0.5 h and 1 h of OLV (T1, T2 ) and 4 h and 24 h after operation (T3, T4 )for blood gas analysis and determination of plasma TNF-α, IL-6 and IL-10 concentrations. Respiratory index (RI)was calculated. (RI= PA-a O2 /PaO2 ).Results Compared with the baseline values at To, plasma TNF-α and IL-6 concentrations and RI at T1-4 and plasma IL-10 concentrations at T1-3 were all significantly increased in group C,while in group U plasma TNF-α and IL-6 concentrations at T2,3 and plasma IL-10 concentrations and RI at T1-4 were all significantly increased ( P ＜ 0.05 ). Plasma TNF-α and IL-6 concentrations and RI were significantly lower while plasma IL-10 concentration was significantly higher in group U than in group C (P ＜ 0.05).Conclusion Ulinastatin 10 000 U/kg can effectively protect the lungs in patients with lung cancer undergoing lobectomy by attenuating systemic inflammatory response. Key words: Trypsin inhibitors; Pneumonectomy; Lung neoplasms