右美托咪啶对肺癌根治术患者围术期炎性反应及肺功能的影响

Effect of dexmedetomidine on inflammatory response and pulmonary function during perioperative period in patients undergoing radical for lung cancer

目的评价右美托咪啶对肺癌根治术患者围术期炎性反应及肺功能的影响。方法选取择期全麻下行肺癌根治术患者40例,采用随机数字表法将其随机分为两组：右美托咪啶组（D组）和生理盐水对照组（C组）,每组20例。麻醉诱导前,D组经10 min静脉输注右美托咪啶1.0μg/kg,随后以0.5μg/（kg·h）速度输注至术毕前30 min;C组以同样方法静脉输注等容量生理盐水。分别于麻醉诱导前（T0）、单肺通气（OLV）前（T1）、单肺通气30 min时（T2）、膨肺后30 min时（T3）、术后24 h时（T4）采集动脉血测定血气,计算肺泡-动脉氧分压差[P（（A-a））O2]和呼吸指数（RI）;于T1~T3时记录气道平台压（P（plat））及气道峰压（P（peak））,计算肺顺应性（Cd）;并于T0~T4时采集静脉血样计数全血中性粒细胞（PMN）,测定血清肿瘤坏死因子α（TNF-α）、白细胞介素-6（IL-6）和白细胞介素-10（IL-10）浓度。结果与T0时比较,T1~T3时两组患者动脉血氧分压（PaO2）、P（（A-a））O2及RI升高;T1~T4时,PMN计数、血清TNF-α、IL-6及IL-10浓度升高（P〈0.05）;与T1时比较,T3时C组气道平台压及P（peak）升高,Cd降低,D组P（plat）及P（peak）降低,Cd升高（P〈0.05）;与C组比较,D组T2~T3时PaO2及Cd升高P（plat）、P（peak）、P（（A-a））O2及RI降低;T2~T4时,PMN计数、血清TNF-α及IL-6浓度降低,IL-10浓度升高（p〈0.05）。结论右美托咪啶可减轻肺癌根治术患者围术期炎性反应,改善患者肺功能。

Objective To investigate the effect of dexmedetomidine on pulmonary function and inflammatory response during perioper-ative period in patients undergoing radical for lung cancer. Methods Totally 40 patients undergoing elective radical for lung cancer were randomly divided into two groups：Dexmedetomidin group（ Group D） and control group （ Group C） （ n=20 each） . Dexmedetomi-dine 1 μg/kg was infused iv over 10 minutes before anesthesia induction,and then was infused at a rate of 0. 5 μg/（ kg＆#183;h） until 30 minutes before the end of operation in Group D. Group C received the equal volume of normal saline. Arterial blood samples were col-lected for blood gas analysis before anesthesia induction （ T0 ） ,before one lung ventilation（ OLV） （ T1 ） ,at 30 minutes of OLV （ T2 ） , at 30 minutes after lung inflate （T3） and at 24 hours after operation （T4）,P（A-a）O2 and respiratory index （RI） was calculated. The airway platform pressure （ Pplat ） and peak pressure （ Ppeak ） was recorded,and lung dynamic compliance （ Cd） was calculated at T1 ,T2 and T3 . Blood samples were collected for detection of the PMN count,serum level of TNF-α,IL-6 and IL-10 at T0 -T4 . Results Com-pared with T0 ,PaO2 ,P（A-a） O2 and RI were increased at T1 -T3 ,the PMN count,serum level of TNF-α,IL-6 and IL-10 were increased at T1 -T4 in the two groups（P〈0. 05）. Compared with T1, Pplat and Ppeak was increased,Cd was decreased at T3 in group C,while Pplat and Ppeak were decreased,Cd was increased at T3 in group D （P〈0. 05）. Compared with group C,PaO2 and Cd were increased,Pplat, Ppeak,P（A-a）O2 and RI was decreased at T2 -T3,the PMN count,serum level of TNF-αand IL-6 were decreased,and the serum level of IL-10 was increased at T1 -T4 in the group D （P〈0. 05）. Conclusion Dexmedetomidine can reduce inflammatory response and im-prove the lung function during perioperative period in patients undergoing radical for lung cancer.