右美托咪定在眼科手术中肺保护作用研究

Study on the pulmonary protective effect of dexmedetomidine in ophthalmic surgery

目的研究右美托咪定静脉注射对呼吸机相关性肺损伤(VILI)是否具有保护作用。方法选择沧州市中心医院择期行双侧斜视矫正术患儿为研究对象。随机分为两组:右美托咪定组(D组)、对照组(P组),每组各30例。麻醉诱导前D组静脉输注右美托咪定负荷量0.5 μg/kg,输注时间为15 min,然后以0.05 μg·kg-1·min-1泵注至手术结束前半小时。P组给予相同容量的生理盐水。两组患者分别于麻醉诱导后(T1)、手术开始30 min(T2)、手术结束(T3)及术后6 h(T4)时采集桡动脉血样3 ml。2 ml采用酶联免疫吸附法测定血浆肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和IL-8的浓度,1 ml进行血气分析,记录动脉血氧分压(PaO2)和二氧化碳分压(PaCO2),计算肺氧合指数(OI)及呼吸指数(RI)。结果与P组比较D组在T2,T3时TNF-α、IL-6、IL-8水平降低,OI升高,RI降低(P<0.05);两组T1与T4比较上述炎性因子水平与OI、RI差异无统计学意义(P>0.05)。结论右美托咪定可抑制炎性因子的释放并且改善肺功能而达到肺保护作用,短时间的机械通气引起的肺损伤是一过性的,无论是否使用右美托咪定在术后6 h炎性因子及肺功能都能恢复至术前水平。

Objective To investigate whether dexmedetomidine intravenous injection has protective effects on ventilator-associated lung injury (VILI). Methods The children with bilateral strabismus who underwent selective strabismus correction in Cangzhou Central Hospital were selected as the study subjects.They were randomly divided into two groups: dexmedetomidine group (group D), and control group (group P), 30 cases in each group.Before the induction of anesthesia, the infusion of dexmedetomidine in the D group was 0.5 μg/kg for 15 min, Then pumped at 0.05 μg·kg-1·min-1 to half an hour before the end of the procedure.Group P was given the same volume of physiological saline.The two groups of patients received 3 ml of radial artery blood samples after induction of anesthesia (T1), 30 minutes after the start of surgery (T2), and 6 hours after surgery (T4). The concentrations of plasma tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) and IL-8 were determined by enzyme-linked immunosorbent assay in 2 ml.1 ml for blood gas analysis.We recorded arterial oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2), and calculated the pulmonary oxygenation index (OI) and respiratory index (RI). Results Compared with group P, the levels of TNF-α, IL-6 and IL-8 were decreased in group D at T2 and T3, OI increased, RI decreased (P<0.05);There showed no significant difference in the levels of inflammatory factors and OI and RI between T1 and T4 in the two groups (P>0.05). ConclusionsDexmedetomidine inhibits the release of inflammatory factors and improves lung function to achieve lung protection, lung injury caused by short-term mechanical ventilation is transient, regardless of whether dexmedetomidine was used or not, inflammatory factors and lung function returned to preoperative levels 6 h after surgery.