右美托咪定在全腔镜食管癌根治术ERAS管理中的肺保护效应

The lung protection of dexmedetomidine in ERAS management of patient with the total minimal invasive esophagectomy

目的探讨盐酸右美托咪定对全腔镜食管癌根治术患者围术期加速康复外科(ERAS)管理中的肺保护作用。方法选择择期行全腔镜下食管癌根治术患者60例,ASAⅠ~Ⅱ级,术前严格戒烟2周,肺功能正常,随机分为右美托咪定组(D组)及对照组(C组)。两组患者接受相同的麻醉诱导和维持方案。D组在麻醉诱导即刻给予右美托咪定0.4μg/(kg·h)持续输注直至术毕前1 h,C组输注等量生理盐水。分别于入室后(T1)、胸腔游离食管操作完毕平卧位后(T2)、腹部手术结束即刻(T3)和术毕即刻(T4)采取静脉血,检测血浆炎症因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。于术后第2天随访患者,采用临床肺部感染评分(CPIS)评估肺炎发生情况。观察记录两组患者总的住院时间及抗生素使用时间。结果与C组相比,在T1时D组患者静脉血浆IL-6、TNF-α水平差异无统计学意义(P>0.05),但其他各时点D组血浆IL-6、TNF-α水平降低,差异有统计学意义(P<0.05)。与C组相比,术后第2天D组CPIS评分降低,D组抗生素使用时间缩短(P<0.05),两组住院总时间差异无统计学意义(P>0.05)。结论盐酸右美托咪定能减少全腔镜食管癌根治术患者炎症因子的释放,减轻术后肺部感染评分,从而对肺脏起到一定保护作用,并且缩短抗生素使用时间,是ERAS管理药物干预的新选择。

Objective To study the protective effect of dexmedetomidine on lung in the enhanced recovery after surgery（ERAS） management for patients with total minimal invasive esophagectomy （MIE）. Methods Sixty patients with MIE in our hospital （ ASA Ⅰ or Ⅱ ）, with normal pulmonary function were included and randomly divided in to two groups （n=30 ）, dexmedetomidine group （Group D） and control group （Group C ）. Before operation, patients quited smoking at least two weeks. Group D received a continuous intravenous dexmedetomidine [0.4 μg/（ kg·h ） ] infusion from the time of anesthesia induction until one hour before the operation over. Group C was given with placebo saline with a same speed. Serum IL - 6 and TNF - α levels were compared immediately after entry into the operating room （ T1 ） , after thoracic surgery （T2） , and at the end of experimental drug infusion （T3）. Clinical pulmonary infection score （CPIS） 48 h after operation was evaluated. The total hospital stay and the duration of antibiotics therapy were recorded for comparison. Results Application of dexmedetomidine hydrochloride in the patients with MIE significantly attenuated the levels of IL - 6 and TNF - α, and reduced the postoperative CIPS （ P 〈 0. 05 ）. The duration of antibiotics therapy was also significantly shortened by 1 day in Group D. Conclusion Dexmedetomidine protects the lung through attenuating the levels of IL - 6 and TNF - α ; reduces postoperative CIPS and shortens the use of antibiotics.