盐酸右美托咪定对单肺通气患者炎症反应的影响

Dexmedetomidine Hydrochloride effects on Inflammatory During one Lung Ventilation

目的：探讨盐酸右美托咪定对实施食管癌根治术患者单肺通气时炎症反应的影响。方法：选择择期行食管癌根治术的42例患者,采用完全随机法分为盐酸右美托咪定组（D组）和对照组（C组）,各21例。D组于麻醉诱导前10min经静脉输注盐酸右美托咪定1.0μg/kg,然后按0.5μg/（kg·h）的速率继续输注至术毕前30min;C组经静脉给予等容量生理盐水。分别于麻醉诱导前（T_0）、单肺通气即刻（T_1）、单肺通气开始30min（T_2）、90min（T_3）、双肺通气即刻（T_4）和术毕（T_5）时间点采用ELISA法检测患者血浆中TNF-α和IL-6的浓度,并测定中性粒细胞核蛋白NF-κB活性。结果：与C组相比,D组在T_2~T_5时刻血浆中TNF-α和IL-6的浓度和中性粒细胞核蛋白NF-κB活性均下降,差异有统计学意义（P〈0.05）。结论：围手术期持续静脉输注盐酸右美托咪定可抑制食管癌根治术患者单肺通气时NF-κB活性,从而减轻炎症反应。

Objective：To investigate the effects of dexmedetomidine hydrochloride on inflammatory during one-lung ventilation （OLV） in the patients undergoing radical resection of esophageal cancer. Method：Forty-two patients who scheduled for radical resection of esophageal cancer surgery under general anesthesia with one lung ventilation were randomly divided into control group （group C） and dexmedetomidine hydrochloride group （group D）, each of 21 cases. Patients in group D were infused with dexmedetomidine hydrochloride 1.0μg/kg in 10 min before anesthesia induction, and then infused at a rate of 0.5 μg/（kg·h）until 30 rain before the end of operation; patients in group C received the equal volume of normal saline. Blood samples were collected before induction of anesthesia （T0）, at the beginning of OLV （T1）, 30 rain （T2） and 90 rain （T3） after OLV, at the beginning of two lung ventilation （T4） and at the end of operation （T5）. Serum TNF-α and IL-6 levels were detemined at above time points. The oxygenation index and respiratory index were calculated. The nuclear protein of neutrophil granulocytes was extracted for measurement of NF-κB DNA-blinding activity. Results：As compared with the group C, the serum concentration of TNF-α and IL-6 and NF-κB DNA-blinding activity were significantly decreased at T2-T5 in the group D. Conclusion： Perioperative contiuous infusion of dexmedetomidine hydrochloride can inhibit the activation of NF-κB DNA-blinding activity in neutrophil granulocytes and is helpful in reducing the inflammatory response in patients undergoing general anesthesia with one-lung ventilation.