右美托咪定对行肺癌根治术的患者围手术期炎症及肺功能保护作用的影响

Protective effect of dexmedetomidine against perioperative inflammation and on pulmonary function in patients undergoing radical resection of lung cancer

目的探讨右美托咪定对行肺癌根治术的患者围手术期炎症及肺功能保护作用的影响。方法选取我院2014年5月~2016年5月的124例肺癌根治术患者进行研究,随机分为试验组和对照组各62例,对照组采用单一药物麻醉,试验组在对照组的基础上进行右美托咪定麻醉,比较手术开始前(T_0)、单肺通气(OLV)30 min(T_1)、OLV 60 min(T_2)及手术结束(T_3)2组患者的血清中IL-1β、IL-10以及肿瘤坏死因子(TNF)-α水平变化,采用酶联免疫法(ELISA)测定两组术中肺脏组织标本匀浆中丙二醛(MDA)、髓过氧化物酶(MPO)以及黄嘌呤氧化酶(XOD)水平,观察2组的动脉血氧分压(PaO_2)、氧合指数(OI)、气道平台压(APP)和气道阻力(AR)。结果 2组患者在T_1和T_2时间点IL-1β、IL-10、TNF-α、MDA、MPO、XOD均明显升高,而且试验组的IL-1β、IL-10、TNF-α、MDA水平明显低于对照组,MPO、XOD明显高于对照组,差异具有统计学意义(P<0.05);2组患者在T_1和T_2点的PaO_2、OI明显降低,气道平台压和气道阻力明显升高,但是试验组气道平台压和气道阻力明显低于对照组,PaO_2和OI明显高于对照组,差异具有统计学意义(P<0.05)。结论肺癌根治术麻醉患者中采用右美托咪定麻醉可以有效的减轻肺部炎症反应,并对患者的肺功起到重要保护作用。

Objective To study the protective effect of dexmedetomidine against perioperative inflammation and on pulmonary function in patients undergoing radical resection of lung cancer.Methods From May,2014 to May,2016,124 patients with lung cancer receiving radical surgeries were randomized into experimental group(n=62) and control group(n=62).The patients in the control group received a single anesthetic agent for anesthesia,and additional dexmedetomidine was given in the experimental group.The levels of serum interleukin-1β(IL-1β),IL-10,and tumor necrosis factor-alpha(TNF-α) were measured before the operation(T_0),at 30 min(T_1) and 60 min(T_2) during one lung ventilation(OLV) and at the end of operation(T_3).Enzyme-linked immunosorbent assay(ELISA) was used to determine the levels of malondialdehyde(MDA),myeloperoxidase(MPO) and xanthine oxidase(XOD),and the arterial oxygen partial pressure(PaO_2),oxygenation index(OI),airway plateau pressure(APP) and airway resistance(AR) were also recorded.Results At the time points of T1 and T2,IL-1β,IL-10,MDA,MPO,TNF-α,and XOD levels were significantly increased in both of the groups,but the levels of IL-1,IL-10,TNF-α and MDA were significantly lower and MPO and XOD levels significantly higher in the experimental group than in the control group(P<0.05).In both groups,PaO_2 and OI decreased and APP and AR increased significantly at T_1 and T_2,but APP and AR were significantly lower and PaO_2 and OI significantly higher in the experimental group than in the control group(P<0.05).Conclusion Anesthesia with dexmedetomidine in lung cancer patients undergoing radical surgery can effectively reduce the inflammatory response of the lungs and protect the lung function of the patients.