右美托咪啶对单肺通气患者中性粒细胞NF-κB及肺功能的影响

Effects of dexmedetomidine on activity of nuclear factor kappa B and pulmonary function in patients undergoing one-lung ventilation

目的观察右美托咪啶(DEX)对全身麻醉(简称全麻)单肺通气(OLV)肺叶切除术患者中性粒细胞核因子κB(NF-κB)活性及肺功能的影响。方法择期全麻下行肺叶切除术患者40例,ASAⅠ~Ⅱ级。将其分为对照组和DEX组,每组20例。麻醉诱导前DEX组静脉输注DEX 1.00μg/kg,输注时间15min;随后以0.50μg·kg^(-1)·h^(-1)的速率持续输注至术毕前30min。对照组采用同样方法输注等容量生理盐水。分别于气管插管后5min(T_0)、OLV后30min(T_1)、恢复双肺通气后30min(T_2)及术后30min(T_3)时采集桡动脉血样,进行血气分析,计算氧合指数(OI)和呼吸指数(RI),并提取中性粒细胞核蛋白,测定中性粒细胞NF-κB DNA结合活性;同时取颈内静脉血测定血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平。结果与对照组比较,DEX组RI、血清TNF-α、IL-6水平及中性粒细胞NF-κB DNA结合活性明显降低(P<0.05);两组患者OI比较差异无统计学意义(P>0.05)。结论DEX可抑制OLV时中性粒细胞NF-κB激活,下调OLV患者围术期的炎性反应,可改善肺功能。

Objective To observe the effect of dexmedetomidine(DEX)on activity of nuclear factor-kappa B(NF-κB)and pulmonary function during one-lung ventilation(OLV)in patients undergoing lobectomy of lung.Methods Forty patients with American Society of Anesthesiologists(ASA)I~Ⅱunderwent lobectomy,they were divided into two groups(n=20):the control group and the DEX group.Before the induction of anesthesia,the DEX group received DEX 1.00μg/kg intravenously for 15 minutes,and it was infused at a rate of 0.50μg·kg-1·h-1 until 30 min before surgical finish.The control group was infused with the same volume of normal saline in the same method.Radial arterial blood samples were collected 5 min after tracheal intubation(T 0),30 min of OLV(T 1),30 min after recovery of lung ventilation(T 2),and 30 min after surgery(T 3).Arterial blood gas analysis was performed to calculate oxygenation index(OI)and respiratory index(RI),extract neutrophil nucleoprotein,and detect neutrophil NF-κB DNA binding activity;simultaneously took jugular vein blood to measure serum tumor necrosis factor-alpha(TNF-α)and interleukin-6(IL-6)levels.Results Compared with the control group,RI and the concentrations of TNF-α,IL-6 and the binding activity of NF-κB DNA in the DEX group significantly decreased(P<0.05),but there was no significant difference in OI(P>0.05).Conclusion DEX can inhibit the activation of NF-κB in neutrophil granulocyte,reduce the inflammatory response in patients undergoing OLV and improve the pulmonary function.