右美托咪定对食管癌手术单肺通气肺损伤的影响

Effects of Dexmedetomidine on lung injury of single lung ventilation in operation of esophageal carcinoma during one lung ventilation

目的 观察炎性细胞因子TNF-α、IL-6、IL-8在手术过程中的变化,探讨右美托咪定对食管癌手术单肺通气患者肺损伤的影响.方法 选择需手术治疗的食管中段癌患者60例,随机分为右美托咪定组（D组）和对照组（C组）.D组麻醉诱导前10 min经静脉泵注右美托咪定1 μg/kg,随后以0.5μg/（kg＆#183;h）的速度持续泵注至术毕前30 min;C组麻醉诱导前10 min给予等量0.9％氯化钠溶液.2组其余麻醉方法相同,分别记录诱导前10 min（t1）、诱导时（t2）、诱导插管后（t3）、单肺通气（OLV） 30 min时（t4）、OLV60 min时（t5）、OLV结束（t6）及出室前（t7）时间点患者心率（HR）、平均动脉压（MAP）、血氧饱和度（Sp（O2））,脑电双频谱指数（BIS）.于t3、t4、t5、t6、t7点各取静脉血5 mL,采用酶联免疫吸附法测定TNF-α、IL-6、IL-8血清浓度.结果 2组各时点MAP、Sp（O2）、BIS值比较差异均无统计学意义（P均＞0.05）.D组HR于t2～t7时均低于t1时（P均＜0.05）;且均显著低于C组（P均＜0.05）.2组TNF-α、IL-6、IL-8血清浓度均于t4～t7时均明显高于t3时（P均＜0.01）,C组于t5～t7时均显著高于D组（P均＜0.05）.结论 右美托咪定可降低食管癌手术患者单肺通气期间肺损伤程度,减慢心率,稳定血流动力学参数,对患者心、肺保护起到积极作用.

Objective It is to observe the change of TNF-α ,IL-6, IL-8 in operation of esophageal carcinoma, and explore the influence of dexmedetomidine on lung injury in patients with one lung ventilation. Methods 60 patients with esoph- ageal carcinoma were selected and divided into dexmedetomidine group （ group D） and control group （ group C） randomly. The patients were injected with dexmedetomidine 1 μg/kg in Group D and equal volume of 0.9% Nacl solution in Group C at 10min before induction of anesthesia, and then all were continually injected dexmedetomidine with 0.5 μg/（ kg · h） until 30min before the end of operation, the MAP, HR, Sp（ O2） and BIS were record at before the induction 10min （t1） , the time of induction （t2 ） , induced after intubation （t3 ） , after one lung ventilation （OLV） 30min （t4 ） , after OLV 60 min （ t5 ） , the end of OLV （ t6 ） ,the end of the operation （ t7 ） . Blood samples were collected at t3 , t4, t5 , t6 , t7 to detect the levels of TNF - α, IL - 6, IL - 8 by enzyme-linked immunosorbent method. Results There was no significant difference in MAP, Sp （ O2 ） , BIS between two groups at each time point （ all P 〉 0.05 ）. HR in group D was markedly slower at t2 to t7 than that at t1 （ P 〈 0.05 ） ; and was markedly slower than that in group C （ P 〈 0.05 ）. The levels of TNF - α, IL - 6 and IL - 8 of two groups at t4 to t7 was significantly higher than at t3 （P 〈 0. 01 ） ; the levels of TNF -α, IL- 6, IL -8 of group C at t4 to t7 was higher than that of group D （P 〈 0.05）. Conclusion Dexmedetomidine can reduce the degree of lung injury during onelung ventila- tion of patients in operation of esophageal carcinoma, on the other hand, it can slow down the HR, stabilize hemodynamic pa- rameters, it can be used as lung protection for thoracic surgery.