关键词: 食管切除术, 乌司他丁, 右美托咪定

Abstract: Objective To observe the effects of ulinastatin combined with dexmedetomidine (DEX) on biomarkers of inflammation and lung injury as well as on lung function during total endoscopic oesophagectomy. 
Methods A total of 90 patients undergoing elective oesohagectomy were selected and divided into control group (Con group) ,DEX group (DEX group) and ulinastatin combined with DEX group (U+DEX group), with 30 patients in each group. DEX group was pumped with 0.5 μg· kg-1·h-1 dexmedetomidine after anesthesia induction until 1 h before surgery. The U+DEX group was given ulinastatin by intravenous infusion of 10 000 units/kg at 30 min before anesthesia, and other procedures were in consistent with the DEX group. Con group was given the same volume of normal saline. Peak airway pressure (Ppeek), thorac-pulmonary compliance (Cdyn), blood oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2) were recorded before lateral decustrine position (T0), at 1 h after OLV (T1), at 1 h after recovery of double lung ventilation (T2), and before extubation at the end of surgery (T3). The levels of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8) and Clara cell protein 16 (CC16) in serum and bronchoalveolar lavage fluid (BALF) were determined by enzyme-linked immunosorbent assay (ELISA) at T0 and T3.  
Results Cdyn, PaCO2 and PaO2 showed a trend of first decreasing and then gradually increasing. There were significant differences in interaction between groups, time points, and time points between groups with respect to Cdyn and PaO2 (P＜0.05), and there were significant differences in interaction between groups and between time points in PaCO2 (P＜0.05). There was no significant difference in interaction in time points between groups (P＞0.05). Compared with Con group, the levels of TNF-α and IL-8 in alveolar lavage fluid and serum of DEX group and U+DEX group were significantly decreased at T3 (P＜0.05). Serum CC16 level was significantly increased, but no significant difference was found in CC16 level in alveolar lavage fluid (P＜0.05). Compared with DEX group, the levels of TNF-α and IL-8 in alveolar lavage fluid and serum of U+DEX group were significantly decreased at T3, but there was no significant difference in the serum CC16 level in alveolar lavage fluid (P＜0.05). 
Conclusion Ulinastatin combined with dexmedetomidine can improve lung function and reduce intraoperative inflammation during total endoscopic oesophagectomy. 

Key words: sophagectomy, ulinastatin, dexmedetomidine