右美托咪定对单肺通气患者外周血肿瘤坏死因子-α、白介素-6水平的影响

Effects of dexmedetomidine on interleukin-6 and tumor necrosis factor-α level in the patients undergoing one lung ventilation

目的 探讨右旋美托咪定对胸科开胸手术单肺通气患者的术中血流动力学及肿瘤坏死因子（TNF-α）、白细胞介素-6（IL-6）的影响.方法 选取择期全麻下行胸科开胸手术的患者40例,ASA Ⅰ～Ⅱ级,随机分为C组（对照组）和D组（右旋美托咪定组）,每组20例.患者入室常规监测无创血压、心电、脉搏血氧饱和度.D组患者预先静脉泵注入右美托咪定0.6 μg/kg,15 min之后进行静脉诱导,并改为维持剂量0.4 μg/kg·h.C组患者以同样方法给予盐水后进行静脉诱导,两组静脉诱导4min后进行双腔气管插管,以纤维支气管镜调整双腔管的位置,连接麻醉机.麻醉维持用七氟烷、舒芬太尼.两组患者均记录进入手术室即刻（T1）、泵入右美托咪定15 min（T2）、气管插管后即刻（T3）、切皮即刻（T4）、单肺通气即刻（T5）和术毕即刻（T6）6个时间点的生命体征.并在进入T1、T5、T6及T7进行抽血检测TNF-α、IL-6的水平.结果 C组患者的年龄（54.2±7.1）岁、体重（65.3±9.0） kg与D组患者的年龄（53.7±6.9）、体重（63.3 ±10.1）kg相比,差异无统计学意义（P＞0.05）.D组在T2、T3、T4时间点血压、心率变化比C组稳定,有统计学意义（P＜0.05）.与C组对比,D组在T6、T7时间点TNF-α、IL-6均降低,有统计学意义（P＜0.05）.结论 右美托咪定不仅改善术前及术后焦虑状态,维持术中稳定的血流动力学之外,还具有一定的抑制炎性因子并产生免疫保护作用.

Objective To investigate the effects of dexmedetomidine （Dex） on interleukin-6（IL-6）,tumor necrosis factor-α （TNF-α） level and hemodynamics in the patients undergoing one lung ventilation （OLV）.Method 40 Patients undergoing one lung ventilation were classified as grade Ⅰ or Ⅱ according to the American Society of Anesthesiologists grading system.The patients were randomly dividede into two groups of dexmedetomidine （group D） or control group （group C）.Electrocardiogram （ECG）,heart rate （HR）,mean arterial pressure （MAP） and saturation of pulse oxygen （SPO2） were monitored during anecthesia.In group D,dexmedetomidine was loaded（0.6 μg/kg） 15 min before anesthesia induction and was infused（0.4 μg/kg/h） during surgery.Group C received saline.In both groups,anesthesia was maintained with sevoflune and sufentanil.ECG,HR and MAP were record before infusion of dexmedetomidine or saline（T1）,after the infusion of dexmedetomidine or saline （T2）,after the induction of anesthesia （T3）,at the beginning of operation （T4）,during OLV （T5）,and at the discontinuance of intravenous anesthetics（T6）.Samples of peripheral blood were taken before infusion of dexmedetomidine or saline（T1）,OLV（T5）,at the discontinuance of intravenous anesthetics （T6）,and 2 hour after the operation （T7）.TNF-α and IL-6 were analyzed in the blood samples.Result The age and weight of patients in group C are （54.2 ± 7.1） years old and （65.3 ± 9.0） kg,in group D are （53.7 ±6.9） years old and（63.3 ± 10.1） kg,there is no statistical difference between two groups（P 〉0.05）.the concentration of IL-6 and TNF-α increased successively at all the time points in two groups（P 〈 0.05）.The concentration of TNF-α and IL-6 in group D were lower than that in group C at T6,T7 time points during the experimental period （P 〈 0.05）.The HR and MAP values in group D at T2,T3 and T4 time points were lower than that at T1 time point（P 〈0.05）,but the HR and MAP values in group C at T2 and T3 time point were significantly higher than that at T1 time point （P 〈 0.05）.Conclusion Dexmedetomidine can inhibit inflammatory response of the patients undergoing OLV.