右美托咪定对食管癌根治术患者单肺通气时肺组织炎症反应的影响

Effects of dexmedetomidine on inflammatory responses in lung tissues during one-lung ventilation in patients undergoing esophageal cancer resection

目的评价右美托咪定对食管癌根治术患者单肺通气时肺组织炎症反应的影响。方法择期行食管癌根治术患者40例，年龄25～65岁，ASA分级Ⅰ或Ⅱ级，BMI 18～25 kg/m2，采用随机数字表法分为2组（n＝20）：右美托咪定组（D组）和对照组（C组）。D组麻醉诱导前经10 min静脉输注右美托咪定负荷量0.6 μg/kg，随后以0.4 μg·kg－1·h－1的速率静脉输注至术毕前30 min；C组给予等容量生理盐水。于气管插管术后（T1）、单肺通气30 min （T2）、60 min（T3）、90 min（T4）和恢复双肺通气30 min（T5）时，采集颈内静脉血标本。于T1～4时收集通气侧支气管肺泡灌洗液（BALF），采用ELISA法测定血浆和BALF TNF-α、IL-6和IL-10浓度。结果与C组比较，D组T5时血浆TNF-α浓度和T4，5时血浆IL-6浓度降低，T4，5时血浆IL-10浓度升高；T4时BALF TNF-α浓度和T3，4时BALF IL-6浓度降低，T4时BALF IL-10浓度升高（P〈0.05）。结论右美托咪定可显著减轻食管癌根治术患者单肺通气时肺组织炎症反应，从而减轻全身炎症反应。

Objective To evaluate the effects of dexmedetomidine on inflammatory responses in lung tissues during one-lung ventilation （OLV） in patients undergoing esophageal cancer resection. Methods Forty American Society of Anesthesiologists physical status I or II patients, aged 25-65 yr, with body mass index of 18-25 kg/m2, scheduled for elective radical resection of esophageal cancer, were divided into 2 groups （n= 20 each） using a random number table： dexmedetomidine group （group D） and control group （ group C）. Dexmedetomidine was infused intravenously in a loading dose of 0. 6 μg/kg over 10 min before induction of anesthesia, followed by an infusion of 0.4 μg · kg-1 · h-1 until 30 min before the end of operation in group D, and the equal volume of normal saline was given instead in group C. After intubation （ T1 ） , at 30, 60 and 90 min of OLV （ T2_4 ） , and at 30 rain after restoration of two-lung ventila- tion （T5） , blood samples were taken from the internal jugular vein. Broncho-alveolar lavage fluid （BALF） in ventilated lung was collected at T1-4. The concentrations of tumor necrosis factor-alpha （TNF-α） , inter- leukin-6 （IL） and IL-IO in plasma and BALF were determined by enzyme-linked immunosorbent assay. Results Compared with group C, the plasma concentrations of TNF-α at T5 and IL-6 at T4.5 were significantly decreased, the plasma concentration of IL-10 was increased at T4,5 , and the concentration of TNF-α in BALF at T4 and concentration of IL-6 in BALF at T3.4 were decreased, and the concentration of IL-10 in BALF was increased at T4 in group D （P〈0.05）. Conclusion Dexmedetomidine can significantly ameliorate the inflammatory responses in lung tissues during OLV, thus reducing systemic inflammatory responses in patients undergoing esophageal cancer resection.