右美托咪定对食管癌根治术单肺通气患者肿瘤坏死因子-α和白细胞介素-6的影响

Effects of dexmedetomidine on plasma concentrations of tumor necrosis factor-α and interleukin-6 in patients undergoing radical esophagectomy with one-lung ventilation

目的观察右美托咪定对食管癌根治术单肺通气患者血浆肿瘤坏死因子（TNF）-α和白细胞介素（IL）-6水平的影响。方法印例拟行食管癌根治术的患者，随机分为D1组、D2组和C组，每组20例。D1组麻醉诱导前0．6μg／kg静脉泵注右美托咪定；D2组麻醉诱导后以0．3μg／（kg·h）静脉泵注右美托咪定；C组为对照组。分别测定麻醉诱导前20min（T0），气管插管后10min（T1），单肺通气30min（T2），单肺通气90min（B）及再次双肺通气后10min（T4）5个时间点血浆中TNF-α和IL-6浓度。结果3组患者血浆TNF-α水平在T3、T4时点较，IU高（P〈0．05）；D1组和D2组在T3（10．5±2．5，11．1±2．6）、T4（11．2±2．4，11．8±2．7）时点较C组增高（P〈0．05）。3组患者血浆IL-6水平在T4时点较T0高（P〈0．05）；D1组和D2组在T4时点（23．2±3．3，23．9±3．2）较C组增高（P〈0．05）。结论术前静脉泵注0．6μg／kg及术中持续以0．3μg／（kg·h）静脉泵注右美托咪定均能抑制食管癌根治术单肺通气患者血浆中TNF-α和IL-6水平升高。

Objective To observe the changes in plasma concentrations of tumor necrosis factor （TNF）-α and interleukin （IL）-6 in patients undergoing radical esophagectomy during one-lung ventila- tion. Methods Sixty patients undergoing open radical esophagectomy Were randomly divided into three groups ： group D1 was given dexmedetomidine intravenously at 0.6μg/kg 20 rain before induction of anes- thesia; group D2 was given dexmedetomidine intravenously at 0. 3μg/（ kg. h） after induction of anesthesia; group C served as control group. The plasma concentrations of TNF-α and IL-6 were measured by using enzyme linked immunosorbent assay （ELISA） at 20 min betore anesthesia induction （T0）, 10 min af- ter tracheal intubation （ T1 ）, 30 min after one-lung ventilation （ T2）, 90 min after one-lung ventilation （T3） and 10 min after resuming two-lung ventilation （T4）. Results As compared with TO, plasma TNF-α concentration was increased critically at T3 and T4 in three groups. Plasma TNF-α concentrations in groups D1 and D2 at T3 （ 10. 5 ± 2. 5, and 11.1 ± 2. 6） and T4 （ 11.2 ± 2.4, and 11.8 ± 2. 7） were lower than that in group C. Plasma IL-6 conce6tration was higher at T4 than that at TO. Plasma IL-6 concentra- tion in group D1 （23.2 ±3.3） and group D2 （23.9±3.2） at T4 was lower than that in group C. Conclu- sion A single bolus dose of 0. 6μg/kg dexmedetomidine before induction of anesthesia could inhibit the production of plasma TNF-α and IL-6 in the patients undergoing radical esophagectomy with one-lung venti- lation. So was the continuous infusion dose of 0. 3 μg/（kg·h） dexmedetomidine;