右美托咪定联合七氟醚对体外循环手术患者肺损伤的影响

Effects of dexmedetomidine combined with sevoflurane on lung injury in patients undergoing cardiopulmonary bypass

目的探讨右美托咪定联合七氟醚对体外循环患者肺损伤的影响。方法择期行体外循环下心脏瓣膜置换术患者80例,随机数表法分为4组:右美托咪定组(D组)、七氟醚组(S组)、右美托咪定联合七氟醚组(DS组)和对照组(C组),每组各20例。D组和DS组在麻醉诱导前10min内泵注0.8μg/kg负荷剂量的右美托咪定,术中继续以0.6μg/(kg·h)持续泵注到手术结束。S组和DS组分别在阻断升主动脉前、阻断升主动脉后、开放升主动脉前和开放升主动脉后各吸入2%的七氟醚15min。分别记录麻醉诱导前(T1)、体外循环后即刻(T2)、手术结束后(T3)、术后1d(T4)的氧合指数(OI)、肺泡-动脉氧分压差[P(A-a)O2]、肺静态顺应性(Cst)、可溶性细胞间黏附分子-1(sICAM-1)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)等水平。采用SPSS21.0软件进行数据处理。结果在T2~T4期,C组患者的TNF-α、IL-8、sICAM-1浓度高于其他3组(P<0.05),DS组患者的TNF-α、IL-8、sICAM-1浓度低于D组和S组(P<0.05)。在T2~T4期,C组患者的P(A-a)O2高于其他3组(P<0.05),OI、Cst低于其他3组(P<0.05);DS组患者的P(A-a)O2低于D组和S组(P<0.05),OI、Cst高于D组和S组(P<0.05)。结论七氟醚联合右美托咪定的麻醉方法能减轻体外循环肺损伤程度,且效果优于七氟醚、右美托咪定单独的复合麻醉。

Objective To investigate the effect of dexmedetomidine combined with sevoflurane on lung injury in the patients undergoing cardiopulmonary bypass.Methods A total of 80 patients scheduled for heart valve replacement under cardiopulmonary bypass were recruited and randomly divided into 4 groups ( n =20): dexmedetomidine group (D group),sevoflurane group (S group),dexmedetomidine combined with sevoflurane group (DS group) and control group.For the patients of groups D and DS,dexmedetomidine were continuously pumped into vein with the loading dose of 0.8 μg/kg 10 min before introduction of general anesthesia,and then the speed was adjusted to 0.6 μg/(kg·h) to the end of surgery.For those from groups S and DS,2% sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked,and also before and after the ascending aorta was opened.Oxygenation index (OI),alveolar-arterial oxygen partial pressure difference [P (A-a) O 2],static compliance (Cst),and plasma levels of tumor necrosis factor-α(TNF-α),interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) were recorded and measured before anesthesia induction (T1),immediately after cardiopulmonary bypass (T2),after surgery (T3),and 1 d after surgery (T4).SPSS statistics 21.0 was used to perform the statistical analysis.Results The plasma levels of TNF-α,IL-8 and sICAM-1 in control group were the highest when compared with those in the other 3 groups at T2-T4 ( P <0.05),and the levels was significantly lower in DS group than those of D group and S group at T2-T4 ( P <0.05).At the time period,the P (A-a) O 2 was significantly higher while the OI and Cst were obviously lower in control group than in the other 3 groups ( P <0.05).And the P (A-a) O 2 of DS group was significantly lower than that of the D group and S group ( P <0.05),and OI and Cst were notably higher than those of the D group and S group ( P <0.05 ).Conclusion Sevoflurane combined with dexmedetomidine can alleviate lung injury in the patients undergoing cardiopulmonary bypass,and the effect is better than the combined anesthesia of sevoflurane and dexmedetomidine alone.