盐酸右美托咪定联合肢体远隔缺血预处理在胸腔镜肺切除术中的疗效评价

Evaluation on the effect of Dexmedetomidine hydrochloride combined with limb remote ischemic preconditioning in patients with thoracoscopic lung resection

目的探讨联合应用盐酸右美托咪定与肢体远隔缺血预处理在胸腔镜肺切除术中的影响。方法收集2015年11月至2016年9月实施择期胸腔镜肺切除手术患者80例,采用随机数字表法分成观察组与对照组,每组各40例,观察组术后实施肢体远隔缺血预处理与右美托咪定护理,对照组仅实施非肢体远隔缺血预处理。分别于上止血带前(T1)、单肺通气后30 min(T2)、术毕(T3)、术毕6h(T4)、术毕2h(T5),计算肺泡-动脉氧分压梯度[P(A-a)DO_2]和肺泡氧合指数(OI),并测定血清中肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、血浆超氧化物歧化酶(SOD)活力、丙二醛(MDA)水平,并观察术后并发症发生情况。结果 T3、T4时观察组的P(A-a)DO_2上升幅度明显低于对照组,差异有统计学意义(P<0.05)。对照组中,与T1相比,T2、T3、T4时P(A-a)DO_2逐渐升高,明显高于T1时,差异有统计学意义(P<0.05)。观察组各时间点P(A-a)DO_2变化不明显(P>0.05)。T4时观察组的OI下降幅度明显低于对照组,差异有统计学意义(P<0.05)。对照组中,与T1时比较,其余时间点OI均明显下降,差异有统计学意义(P<0.05)。观察组各时间点OI间比较,差异均无统计学意义(P>0.05)。与T1时比较,同组其他各时间点TNF-α、IL-6水平均明显升高,差异有统计学意义(P<0.05)。T3、T4时观察组血清SOD下降幅度、MDA水平升高的幅度明显低于对照组,差异有统计学意义(P<0.05)。对照组中,与T1时比较,T3、T4时患者血清中的SOD水平明显降低,MDA水平明显升高,差异均有统计学意义(P<0.05)。观察组各时间点的SOD、MDA水平比较,差异无统计学意义(P>0.05)。2组患者肺部并发症发生率分别为7.5%和12.5%,差异无统计学意义(χ~2=0.556,P=0.356)。结论盐酸右美托咪定联合上臂缺血预处理抑制炎性细胞、减轻SOD消耗的作用,减轻缺血再灌注对肺的损伤,对肺换气及氧合功能影响小。

Objective To study the effect of Dexmedetomidine hydrochloride combined with limb remote ischemic preconditioning in patients with thoracoscopic lung resection.Methods A total of 80 patients with thoracoscopic lung resection were recruited in this study from November 2015 to September 2016,and were divided into control group and observation group by digital method,40 cases in each group.Dexmedetomidine hydrochloride combined with limb remote ischemic were used to protect the patients in the observation group after operating.Only limb remote ischemic protect the patients in the control group.Before operation（T1）,30 min after one-lung ventilation（T2）,operation over（T3）,after operation 6h（T4）,after operation 24h（T5）,calculated P（A-a）DO2 and OI value,detected serum Tumor necrosis factor（TNF）-alpha,interleukin（IL）6,plasma superoxide dismutase（SOD）activity,malondialdehyde（MDA）,and observe the complications in the two groups.Results P（A-a）DO2 at T3,T4 in the observation group increased significantly lower than that in the control group（P〈0.05）.In the control group,compared with that of T1,P（A-a）DO2at T2,T3,T4 increased gradually（P〈0.05）,there were no differences at different time in the observation group（P〉0.05）.OI at T4 in the observation group declined significantly lower than that in the control group（P〈0.05）.In the control group,compared with that of T1,OI at T2,T3,T4,T5 declined gradually（P〈0.05）,there were no differences at different time in the observation group（P〉0.05）.Compared with those at T1,serum TNF-alpha,IL-6levels were significant lower at other times in the two groups（P〈0.05）.Serum MDA at T3,T4 declined and SOD level increased in the observation group obviously lower than those in the control group（P〈0.05）.In the control group,the SOD level significantly decreased,MDA level significantly increased at T3,T4 compared with those at T1（P〈0.05）.In observation group,SOD,MDA levels had no significant differences among each time point（P〉0.05）.The complications in the observation group and control group were 7.5% and 12.5%respectively,the difference wasn′t significant（P〉0.05）.Conclusion Dexmedetomidine hydrochloride combined with limb remote ischemic preconditioning could inhibit the effect of inflammatory cells,reduce the consumption of SOD,reduce ischemia reperfusion injury of lung,also have less influence on pulmonary ventilation and oxygenation function.