右美托咪定对腹膜后腔镜手术患者急性肺损伤的影响

Effect of dexmedetomidine on acute lung injury in patients undergoing retroperitoneal laparoscopic surgery

目的 探讨右美托咪定对腹膜后腔镜手术患者急性肺损伤的影响.方法 择期行腹膜后腔镜肾部分切除术患者40例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄18～ 60岁,体重50～ 80 kg,采用随机数字表法分成2组（n=20）：对照组（C组）和右美托咪定组（Dex组）.Dex组于麻醉诱导前10 min静脉注射右美托咪定负荷量1.0 μg/kg,随后以0.5μg＆#183; kg-1＆#183;h-1的速率输注至术毕,C组给予等容量生理盐水.麻醉后取侧卧位,建立CO2气腹,气腹压12 mmHg.分别于麻醉诱导前（T0）、气腹60 min（T1）、气腹120 min（T2）、放气后15 min（T3）、放气后60 min（T4）时取外周静脉血样,采用ELISA法检测血清MDA、TNF-α、IL-6和Clara细胞分泌蛋白（CC16）的浓度.结果 与T0时比较,C组T1～4时血清MDA、TNF-α、IL-6和CC16浓度升高,Dex组T3,4时血清MDA浓度、T1～4时血清TNF-α和IL-6浓度、T2～4时血清CC16浓度升高（P＜0.05）.与C组比较,Dex组T2～4时血清MDA、TNF-α和CC16浓度、T1～4时血清IL-6浓度降低（P＜0.05）.结论 右美托咪定可减轻腹膜后腔镜于术患者急性肺损伤.

Objective To investigate the effect of dexmedetomidine on acute lung injury in the patients undergoing retroperitoneal laparoscopic surgery.Methods Forty patients of both sexes,aged 18-60 yr,weighing 50-80 kg,of American Society of Anesthesiologist physical status Ⅰ or Ⅱ,scheduled for elective retroperitoneal laparoscopic partial nephrectomy,were divided into either control group （group C,n=20） or dexmedetomidine group （group Dex,n =20） using a random number table.At 10 min before induction of anesthesia,dexmedetomidine was injected intravenously in a loading dose of 1.0 μg/kg,followed by an infusion of 0.5 μg·kg^-1 · h^-1 throughout surgery in group Dex,and the equal volume of normal saline was given instead in group C.The patients were placed in lateral position after anesthesia,and CO2 pneumoperitoneum was induced with an intra-abdominal pressure of 12 mmHg.Before induction of anesthesia （To）,at 60 and 120 min of pneumoperitoneum （T1,2）,and at 15 and 60 min after deflation （T3,4）,peripheral venous blood samples were taken for determination of serum malondialdehyde （MDA）,tumor necrosis factor-alpha （TNF-α）,interleukin-6 （IL-6） and Clara cell 16-kDa secretory protein （CC16） concentrations by enzyme-linked immunosorbent assay.Results Compared with the baseline at T0,the serum MDA,TNF-α,IL-6 and CC16 concentrations were significantly increased at T1-4 in group C,and the serum MDA concentrations at T3,4,serum TNF-α and IL-6 concentrations at T1-4 and serum concentrations of CC16 at T2-4 were significantly increased in group Dex （P〈0.05）.Compared with group C,the serum MDA,TNF-α,and CC16 concentrations at T2-4 and serum IL-6 concentrations at T1-4 were significantly decreased in group Dex （P〈0.05）.Conclusion Dexmedetomidine can reduce acute lung injury in the patients undergoing retrnperitoneal laparoscopic surgery.