地佐辛对食管癌根治术单肺通气患者血流动力学及炎症因子的影响

Effect of Dezocine on Hemodynamics and Inflammatory Cytokines in Esophageal Cancer Patients with One-lung Ventilation

目的：探讨地佐辛对食管癌根治术单肺通气患者血流动力学及炎症因子的影响和安全性。方法：将食管癌患者80例按照随机数字表法分为观察组和对照组,各40例。两组患者均给予长托宁0.5 mg＋咪达唑仑0.1 mg/kg＋芬太尼4μg/kg＋丙泊酚2mg/kg＋顺式阿曲库铵0.15 mg/kg行麻醉诱导,行双腔支气管置管后,泵入丙泊酚4~10 mg/（kg·h）＋瑞芬太尼0.1μg/（kg·min）。观察组患者手术切皮时静脉注射地佐辛注射液1 ml,对照组患者静脉注射等量生理盐水。比较两组患者麻醉诱导前（T_1）、切皮时（T_2）、静注地佐辛/生理盐水后5 min（T_3）、单肺通气30 min（T_4）、恢复双肺通气10 min（T_5）及手术结束时（T_6）的血流动力学指标[心率（HR）、平均动脉压（MAP）]及炎症因子水平,并观察两组患者不良反应发生情况。结果：两组患者T_1、T_5、T_6时HR、MAP比较,差异均无统计学意义（P〉0.05）;观察组患者T_2、T_3、T_4时HR、MAP显著低于对照组,差异有统计学意义（P〈0.05）。两组患者T_1、T_2、T_3时肿瘤坏死因子（T_NF）α、白细胞介素（IL）8及T_1、T_2、T_3、T_4时IL-6比较,差异均无统计学意义（P〉0.05）;观察组患者T_4、T_5、T_6时T_NF-α、IL-8水平及T_5、T_6时IL-6水平显著低于对照组,差异均有统计学意义（P〈0.05）。两组患者均未见明显不良反应发生。结论：地佐辛应用于食管癌根治术单肺通气患者,可使其血流动力学更为稳定,炎症因子表达水平更低,且安全性较好。

OBJECTIVE：T_o discuss the effect and safety of dezocine on hemodynamics and inflammatory cytokines in esophageal cancer patients with one-lung ventilation（OLV）. METHODS：80 esophageal cancer patients were randomly divided into observation group and control group,40 cases in each group. All patients received 0.5 mg penehyclidine hydrochloride＋0.1 mg/kg midazolam＋4 μg/kg fentanyl＋2 mg/kg propofol＋0.15 mg/kg cisatracurium for anesthesia induction,propofol 4-10 mg/（kg·h）＋remifentanil 0.1 μg/（kg·min）were pumped after double-lumen endobronchial catheter. Observation group received 1 mg dezocine by Intravenous injection in surgical skin incision,control group received the same amount of normal saline. Hemodynamic parameters [heart rate（HR）,mean arterial pressure（MAP）] and inflammatory cytokine levels in 2 groups before anesthesia induction（T_1）,when skin incision（T_2）,5 min after dezocine/normal saline（T_3）,OLV 30 min（T_4）,recovery two-lung ventilation 10 min（T_5）and end of the operation（T_6）were compared,and the incidence of adverse reactions was observed. RESULTS：There was no significant difference in HR and MAP in 2 groups at T_1,T_5 and T_6（P〈0.05）;HR and MAP in observation group at T_2,T_3 and T_4were significantly lower than control group,the difference was statistically significant（P〈0.05）. There were no significant differences in T_NF-α and IL-8 at T_1,T_2 and T_3and IL-6 at T_1,T_2,T_3 and T_4between 2 groups（P〈0.05）;TNF-α and IL-8 at T_4,T_5 and T_6and IL-6 at T_5 and T_6in observation group were significantly lower than control group,the differences were statistically significant（P〈0.05）. And there was no obvious adverse reactions during treatment. CONCLUSIONS：Dezocine shows more stable hemodynamics and lower expression level of inflammatory cytokines in esophageal cancer patients with OLV,with good safety.