右美托咪定联合丙泊酚对胸腔镜下肺叶切除术患者单肺通气肺损伤的影响

Effect of Dexmedetomidine Combined with Propofol on Lung Injury in Patients Undergoing Thoracoscopic Lobectomy with Unilateral Ventilation

目的研究右美托咪定联合丙泊酚对胸腔镜下肺叶切除术患者单肺通气肺损伤的影响。方法收集行肺叶切除术患者84例,按照随机数字表法分为4组,即对照组(A组)、丙泊酚组(B组)、右美托咪定组(C组)以及右美托咪定联合丙泊酚组(D组)。4组均采用相同的全身麻醉诱导方式,B组和D组诱导插管后均静脉持续泵注丙泊酚2~4 mg·kg^-1·h^-1,C组和D组经静脉泵注1.0μg/kg负荷剂量的右美托咪定(10 min内输注完毕);A组静脉泵注等量的生理盐水。观察3组患者单肺通气即刻(T1)、30 min(T2)、1 h(T3)和2 h(T4)时的氧合指数(OI)和呼吸指数(RI);全血中性粒细胞(PMN)计数,血清髓过氧化物酶(MPO)、黄嘌呤氧化酶(XOD)活性;术后肺部感染和低氧血症发生率。结果T1时,4组的OI和RI无显著差异;T2~T4时,4组的OI升高,RI降低,且D组变化幅度最大;与T1比较,T2~T4时4组全血PMN计数、血清中MPO浓度、XOD活性均明显升高,且D组变化幅度最小;D组术后肺部感染和低氧血症发生率较A组、B组和C组均显著降低,差别具有统计学意义(P<0.05)。结论右美托咪定联合丙泊酚可抑制胸腔镜下肺叶切除术患者单肺通气时的炎性反应,从而减轻肺损伤,达到保护肺部的目的。

Objective To study the effect of dexmedetomidine combined with propofol on lung injury in patients undergoing thoracoscopic lobectomy.Methods From February 2017 to July 2018,84 patients who underwent lobectomy in our hospital were selected and divided into 3 groups according to the random number table method:control group(group A),propofol group(group B)and dexmedetomidine combined with propofol group(group C).All three groups received the same general anesthesia induction intubation.After induction of intubation,both groups B and C were intravenously injected with propofol,and group C was intravenously pumped with dexmedetomidine at a loading dose of 1.0μg/kg(the infusion was completed within 10 min).Group A was intravenously pumped with the same amount of normal saline.The oxygenation index(OI)and respiratory index(RI)of patients in the three groups at immediate(T1),30 min(T2),1 h(T3),and 2 h(T4)of one lung ventilation were observed.We also collected the information on plasma concentrations of TNF-α(tumor necrosis factor),IL-1(interleukin-1),and IL-10(interleukin-10).We also observed incidence of postoperative pulmonary infection and hypoxemia.Results At T1,there was no significant difference in OI and RI among the three groups.Compared with groups A and B at T2,T3 and T4,OI increased and RI decreased in group C.Plasma concentrations of TNF-a and IL-1 decreased at T3 and T4,and IL-10 increased at T4.The incidence of postoperative pulmonary infection and hypoxemia in group C was also significantly lower than that in group A and group B,with statistically significant differences(P<0.05).Conclusion Dexmedetomidine combined with propofol can inhibit the inflammatory response of patients with one-lung ventilation during thoracoscopic lobectomy therefore reduce lung injury and protect patients′lungs.