右美托咪定对食管癌手术中单肺通气肺损伤的影响

The effects of dexmedetomidine on one lung ventilation induced lung injury in esophageal carcinoma patients

目的观察右美托咪定对食管癌手术单肺通气(OLV)肺损伤是否具有肺保护作用。方法选择40例择期行食管癌切除术的患者,按随机数字表法分为右美托咪定处理组(D组)和对照组(C组),每组20例。D组麻醉诱导前10min静脉输注右美托咪定1μg/kg,后恒速静脉输注0.5μg·kg-1·h-1至术毕前30min,C组采用同样方法静脉输注等容量0.9%氯化钠注射液。其余麻醉方案2组相同。分别于麻醉诱导后5min(T0),OLV开始后1h(T1)及2h(T2),OLV结束后1h(T3)及24h(T4),抽取桡动脉血,测定动脉血气计算呼吸指数(RI)、氧合指数(OI)及动脉肺泡氧分压比(PaO2)/(PAO2),并测定血清肺表面活性物质相关蛋白A(SP-A)浓度。结果 2组患者的性别、年龄、体质量、手术时间、OLV时间等差异无统计学意义(P>0.05)。与T0比较,T1、T2与T3时2组患者的肺功能指标水平皆明显降低(P<0.05),血清SP-A浓度明显升高(P<0.05),T4时恢复至术前水平(P>0.05);与C组比较,D组患者在T1与T2时的肺功能指标水平较高(P<0.05),血清SP-A浓度较低(P<0.05)。结论右美托咪定可减轻食管癌手术患者术后的肺氧合功能下降,减轻肺血管通透性增高和肺泡-毛细血管屏障损伤,对食管癌手术患者术后肺损伤的早期恢复具有积极作用。

Objective To investigate the protective effects of dexmedetomidine on one lung ventilation（OLV）induced lung injury in patients who underwent esophageal carcinoma resection.Methods Forty patients underwent esophageal carcinoma resection were randomized into two groups：dexmedetomidine group（D group）and control group（C group）.D group received dexmedetomidine during the operation whereas C group was given normal saline.Blood samples were taken from radial artery at the time-points of 5min after anesthesia（T0）,1h（T1）and 2h（T2）after the beginning of OLV,1h（T3）and 24h（T4）after the end of OLV.Arterial blood gas analysis was given immediately to obtain respiratory index（RI）,oxygen index（OI）and PaO2/PAO2,and the concentrations of pulmonary surfactant-associated protein A（SP-A）in blood serum were measured after all samples collected.Results At T1,T2 and T3,the lung function markers degraded and SP-A concentrations increased significantly compared to baseline（T0）in both groups（P〈0.05）.At T1 and T2,the lung function markers were significantly higher and SP-A concentrations were significantly lower in D group than those in C group（P 〈0.05）.Conclusion Dexmedetomidine has the protective effect on OLV induced lung injury in patients who underwent esophageal carcinoma resection.