右美托咪定对抑制单肺通气再灌注炎性反应的影响分析

Influence analysis of dexmedetomidine on refraining single lung ventilation reperfusion inflammatory reaction

目的探讨右美托咪定对抑制单肺通气(OLV)再灌注的炎性反应的影响。方法选择70例择期行单肺机械通气的手术患者作为研究对象,随机分为2组(n=35):观察组与对照组。观察组在麻醉开始诱导前10 min,静脉持续泵入负荷剂量右美托咪定1μg/kg,之后以0.5μg(kg·h)的速度泵注至手术结束。诱导采用咪达唑仑、舒芬太尼、丙泊酚、顺式阿曲库铵静脉注射。对照组给予静脉滴注等容量0.9%氯化钠注射液,其余麻醉诱导与维持同观察组。比较手术期间各时间点各指标的变化。结果两组患者手术结束时的MDA、TNF-a、IL-6、浓度均明显高于麻醉诱导前,血清SOD活性低于麻醉诱导前,差异均有统计学意义(均P<0.05);观察组手术结束时的TNF-a、IL-6、MDA浓度均明显低于对照组,血清SOD活性高于对照组,差异均有统计学意义(均P<0.05)。结论右美托咪定可有效抑制OLV通气再灌注的炎性反应,减轻OLV时肺脏的缺血再灌注损伤,对肺脏可能具有积极保护作用。

Objective To discuss the influence of dexmedetomidine on refraining single lung ventilation reperfusion （OLV） inflammatory reaction.Methods 70 cases undergoing elective one lung mechanical ventilation were taken as the research objects, and they were randomly divided into 2 groups （n=35）.In the observation group, 10 minutes before induction of anesthesia, dexmedetomidine was continuously pumped into vein with the loading dose of 1.0 μg/kg, and then the speed was adjusted to 0.5 μg/（kg·h） to the end of surgery.The induction of anesthesia was successively injected into vein with midazolam, sufentanil, propofol and cisatracurium.The control group were treated with intravenous injection of equal volume of 0.9% sodium chloride injection.The other methods of induction of anesthesia and maintenance were the same as the observation group.The change of the indexes at each time point during the operation was compared.Results The concentration of MDA, TNF-a and IL-6 in the two groups were significantly higher than before the induction of anesthesia, and the activity of serum SOD was lower than before the induction of anesthesia （all P〈0.05）.At the end of the surgery, the concentration of MDA, TNF-a and IL-6 in the observation group was significantly lower than that in the control group, and the activity of serum SOD was higher than in the control group （all P〈0.05）.Conclusion The dexmedetomidine can effectively restrain the inflammatory reaction from OLV ventilation reperfusion and reduce lung ischemia-reperfusion injury when OLV, which may have a positive protective effect on lung.