麻醉因素对双肺移植术围术期炎性反应的影响：右美托咪定复合麻醉的优势

Effect of anesthetic factors on perioperative inflammatory responses in bilateral lung transplantation： advantages of dexmedetomidine-based anesthesia

目的评价右美托咪定复合麻醉对双肺移植术患者围术期炎性反应的影响。方法选择双肺移植术患者56例，年龄18～64岁，体重45～65 kg，ASA分级Ⅲ或Ⅳ级，采用随机数字表法分为2组（n＝28）：常规麻醉组（R组）和右美托咪定复合麻醉组（D组）。D组静脉输注右美托咪定1.0 μg/kg 10 min，随后以0.5 μg·kg^－1·h^－1的速度静脉输注，静脉输注丙泊酚4～6 mg·kg^－1·h^－1、顺苯磺酸阿曲库铵0.05 mg·kg^－1·h^－1、瑞芬太尼0.1～0.3 μg·kg^－1·min^－1，吸入1%～2%七氟醚，R组除未使用右美托咪定外，麻醉维持方法同D组。于麻醉诱导前、气管插管后即刻、单肺通气后即刻、30、60 min、双肺通气即刻、30、60 min、术毕时、术后12和24 h时（T0-10）抽取桡动脉血标本，采用ELISA法测定血清TNF-α、IL-6、IL-8浓度。记录气管拔管时间。结果与R组比较，D组T3-10时血清TNF-α、IL-6、IL-8浓度降低，气管拔管时间缩短（P〈0.05）。结论右美托咪定复合麻醉可降低双肺移植术患者围术期炎性反应，有助于改善预后。

Objective To evaluate the effect of anesthetic factors on perioperative inflammatory responses in bilateral lung transplantation.Methods Fifty-six American Society of Anesthesiologists physical status Ⅲ or Ⅳpatients, aged 18-64 yr, weighing 45-65 kg, undergoing elective bilateral lung transplantation, were divided into 2 groups（n=28 each）using a random number table： routine anesthesia group（group R）and dexmedetomidine-based anesthesia group（group D）. In group D, dexmedetomidine was intravenously infused as a dose of 1.0 μg/kg for 10 min followed by an infusion of 0.5 μg·kg^-1·h^-1, propofol 4-6 mg·kg^-1·h^-1, cisatracurium besylate 0.05 mg·kg^-1·h^-1 and remifentanil 0.1-0.3 μg·kg^-1·min^-1 were intravenously infused and 1%-2% sevoflurane was inhaled.In group R, the method for anesthesia maintenance was similar to that previously described in group D except dexmedetomidine.Before anesthesia induction, immediately after intubation, immediately after one-lung ventilation, at 30 and 60 min after one-lung ventilation, immediately after two-lung ventilation, at 30 and 60 min after two-lung ventilation, at the end of surgery and at 12 and 24 h after surgery（T0-10）, blood samples were collected from the radial artery for determination of serum tumor necrosis factor-alpha, interleukin-6（IL-6）and IL-8 levels by enzyme-linked immunosorbent assay.The extubation time was recorded.Results The serum concentrations of tumor necrosis factor-alpha, IL-6 and IL-8 were significantly lower at T3-10, and the extubation time was shorter in group D than in group R（P〈0.05）.Conclusion Dexmedetomidine-based anesthesia can decrease perioperative inflammatory responses and is helpful in improving prognesis in the patients undergoing bilateral lung transplantation.