右美托咪定对肺叶切除术患者单肺通气时中性粒细胞NF-κB活性的影响

Effects of dexmedetomidine on activity of nuclear factor kappa B in neutrophil granulocytes during one-lung ventilation in patients undergoing pulmonary lobectomy

目的 评价右美托咪定对肺叶切除术患者单肺通气时中性粒细胞NF-κB活性的影响.方法 择期全麻下行肺叶切除术患者38例,ASA分级Ⅰ或Ⅱ级,年龄40 ～ 64岁,体重50 ～ 75 kg,采用随机数字表法分为2组（n=19）：对照组（C组）和右美托咪定组（D组）.麻醉诱导前D组经15 min静脉输注右美托咪定1.0 μg/kg,随后以0.5 μ g·kg-1 ·h-1的速率输注至术毕前30 min;C组静脉输注等容量生理盐水.分别于气管插管后5 min、单肺通气即刻、单肺通气30、60 min、恢复双肺通气即刻、恢复双肺通气30 min及术后30 min时,采集桡动脉血样,行血气分析,计算氧合指数和呼吸指数,提取中性粒细胞核蛋白,测定NF-κB DNA结合活性,采用ELISA法测定血浆TNF-α和IL-6的浓度.结果 与C组比较,D组呼吸指数、血浆TNF-α、IL-6的浓度和中性粒细胞NF-κB DNA结合活性降低（P＜0.05）;2组氧合指数比较差异无统计学意义（P＞0.05）.结论 右美托咪定可抑制肺叶切除术患者单肺通气时中性粒细胞NF-κB的激活,有助于减轻全身炎性反应.

Objective To evaluate the effects of dexmedetomidine on the activity of nuclear factor kappa B （NF-κB） in neutrophil granulocytes during one-lung ventilation in the patients undergoing pulmonary lobectomy.Methods Thirty-eight ASA physical status Ⅰ or Ⅱ patients,aged 40-64 yr,weighing 50-75 kg,scheduled for elective pulmonary lobectomy,were randomized into 2 groups （n =19 each） using a random number table：control group （group C） and dexmedetomidine group （group D）.In group D,dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min before induction of anesthesia,followed by infusion at a rate of 0.5 μg· kg-1 · h-1 until 30 min before the end of operation.The equal volume of normal saline was given in group C.At 5 min after intubation,0,30 and 60 min of one-lung ventilation,0 and 30 min of two-lung ventilation,and 30 min after operation,blood samples were taken from the radial artery for blood gas analysis and for measurement of plasma concentrations of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6）.The oxygenation index and respiratory index were calculated.The nuclear protein of neutrophil granulocytes was extracted for measurement of NF-κB DNA-binding activity.Results Compared with group C,the respiratory index,plasma concentrations of TNF-α and IL-6 and NF-κB DNA-binding activity were significantly decreased,and no significant difference was found in the oxygenation index in group D.Conclusion Dexmedetomidine can inhibit the activation of NF-κB in neutrophil granulocytes and is helpful in reducing the systemic inflammatory responses during one-lung ventilation in the patients undergoing pulmonary lobectomy.