右美托咪定联合依托咪酯对食管癌单肺通气肺损伤的影响

Effects of dexmedetomidine combined with etomidate on lung injury induced by one lung ventilation in patients with esophagus cancer

目的探讨右美托味定(dexmedetomidine,DEX)伍用依托咪酯对食管癌单肺通气(one lung ventilation,OLV)的肺保护作用及机制。方法选择84例择期行单肺通气食管癌患者为对象,分为A组:依托咪酯组(0.2 mg·kg^(-1)·h^(-1));B组:DEX组(0.3μg·kg^(-1)·h^(-1));C组:0.3μg·kg^(-1)·h^(-1)DEX+0.2 mg·kg^(-1)·h^(-1)依托咪酯组,每组28例。于麻醉诱导前15 min(T0)、单肺通气即刻(T1)、单肺通气1 h(T2)、单肺通气1.5 h(T3)、术后24 h(T4)采集静脉血3 ml。运用血气分析仪和血细胞计数仪对静脉血气分析和中性粒细胞(PMN)计数。运用ELISA法测定血浆中髓过氧化酶(MPO)、黄嘌呤氧化酶(XOD)、血管内皮生长因子(VEGF)、一氧化氮(NO)及白介素-1β(IL-1β)、IL-6、IL-10和肿瘤坏死因子-α(TNF-α)的浓度;记录各用药量、手术时间、单肺通气时间、可唤醒时间。结果与A组比较,B组和C组患者用药量减少、可唤醒时间延长(P<0.05)。组内比较:与T0时比较,T2~T4时3组患者PMN计数、血清MPO浓度、VEGF浓度显著增高(P<0.05)。组间比较:T2~T4时B组和C组PMN计数和MPO浓度显著低于A组(P<0.05),C组PMN计数和MPO浓度显著低于B组(P<0.05);B组和C组T3、T4时VEGF明显低于A组(P<0.05),C组T3、T4时血清VEGF明显低于B组(P<0.05);T2~T4时B组和C组NO浓度明显高于A组(P<0.05)。T2~T4时A组IL-6和IL-10水平显著高于T0(P<0.05)。3组IL-6和IL-10水平比较,A组>B组>C组,差异有统计学意义(P<0.05)。结论右美托咪定联合依托咪酯可减少用药量,通过降低OLV患者MPO、XOD浓度及PMN计数减轻肺缺血-再灌注损伤,降低IL-6和IL-10浓度抑制炎性反应发挥肺保护作用。

Objective To investigate the preventive effects of dexmedetomidine（ DEX） combined with etomidate on lung injury induced by one lung ventilation（ PLV） in patients with esophagus cancer. Methods A total of 84 patents with esophagus cancers who were scheduled for selective OLV operation were divided into three groups,with 28 cases in each group. The patients in group A were treated by etomidate 0. 2 mg · kg^（-1）·h^（-1）,and the patients in group B were treated by DEX 0. 3 μg · kg^（-1）· h^（-1）,moreover,the patients in group C were treated by etomidate 0. 3μg · kg^（-1）· h^（-1） DEX ＋0. 2 mg·kg^（-1）·h^（-1）. The venous blood 3 ml was collected at 15 min before anesthesia induction（ T0）,OLV instantly（ T1）,1 h OLV（ T2）,1. 5 h OLV（ T3）,24 h postoperative（ T4）,respectively. Mixed venous blood gas was analyzed by using blood-gas analyzer,and polymorphonuclear neutrophils（ PMN） were counted by using full blood count analyzer at T0 ~ T4. Moreover the levels of myeloperoxidase（ MPO）,xanthine oxidase（ XOD）,vascular endothelial growth factor（ VEGF）,nitric oxide（ NO）,IL-1β,IL-6,IL-10,TNF-α were detected. In addition the drug dosage,operation time,OLV time and wake up time were observed and compared among the three groups. Results As compared with that in Group A,the dosage of drugs in group B and group C was significantly decreased,and wake up time was significantly increased,（ P〈0. 05）. In intra-group comparison： as compared with those at T0,the PMN counts,MPO and VEGF concentration in the three group were significantly increased at T2 ~ T4（ P〈0. 05）. In comparison among groups： PMN counts and MPO concentration in group B and group C at T2 ~ T4 time were significantly lower than those in group A（ P〈0. 05）,moreover,PMN counts and MPO concentration in group C were significantly lower than those in group B（ P〈0. 05）. In addition the levels of VEGF in group B and group C at T3,T4 were significantly lower than those in group A（ P〈0. 05）,moreover,the levels of VEGF in group C at T3,T4 were significantly lower than those in group B（ P〈0. 05）.The levels of NO in group B and group C at T2 ~ T4 were significantly higher than those in group A（ P〈0. 05）. Besides the levels of IL-6 and IL-10 in group A at T2 ~ T4 were significantly higher than those at T0（ P〈0. 05）,there were significant differences in the levels of IL-6 and IL-10 among the three groups（ group A group B group C（ P〈0. 05）. Conclusion DEX combined with etomidate can reduce the dosage of drugs in OLV operation in treatment esophagus cancer through reducing the concentration of MPO,XOD and PMN counts to relieve pulmonary ischemia-reperfusion injury and by reducing the levels of IL-6 and IL-10 to inhibit inflammation reaction to protect lung function of patients.