全麻复合右美托咪定对手术切除肺癌通气患者PMN计数的影响

Effect of General Anesthesia Combined with Dexmedetomidine on PMN Count in Patients Undergoing Lung Cancer Ventilation after Surgical Resection

目的探究全麻复合右美托咪定对手术切除肺癌通气患者中性粒细胞(PMN)计数的影响。方法选择单肺通气麻醉状态下实施手术切除治疗的72例肺癌患者为研究对象,按照随机数字表法将其均分为研究组和对照组,每组各36例患者。研究组患者在麻醉诱导前静脉泵注右美托咪定注射液,对照组患者静脉泵注相同计量的生理盐水。分别记录2组患者麻醉诱导即刻(T0)、单肺通气30 min(T1)、单肺通气60 min(T2)、手术结束(T3)4个时间点的PMN计数、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平,并对比4个时间点2组患者氧合指数(OI)、呼吸指数(RI)以及动脉肺泡氧分压比(PaO 2/PAO 2),最后对比2组患者手术情况及术中各类麻醉药物应用情况。结果(1)2组患者T1、T2、T3时PMN计数、IL-6及TNF-α水平明显高于T0时刻(P<0.05),同时组间对比研究组患者上述指标均低于对照组(P<0.05)。(2)T0及T3时刻,2组患者OI、RI及PaO 2/PAO 2对比差异不具有统计学意义(P>0.05),T1及T2时刻2组患者RI高于T0及T3时,OI及PaO 2/PAO 2低于T0及T3时(P<0.05),且研究组优于对照组(P<0.05)。(3)2组患者一般手术情况如术中出血量、24 h尿量、术中补液量对比差异不具有统计学意义(P>0.05),但研究组苏醒时间长于对照组(P<0.05)。(4)研究组患者瑞芬太尼及异丙酚用量低于对照组(P<0.05),顺式阿曲库铵2组用量对比差异不具有统计学意义(P>0.05)。结论右美托咪定能够减轻肺癌手术切除患者术中炎症反应,降低其PMN计数,具有一定的肺保护功能,值得进行临床推广使用。

Objective To explore the effect of general anesthesia combined with dexmedetomidine on the neutrophil count in patients with lung cancer undergoing surgical resection and ventilation.Methods 72 patients with lung cancer who underwent surgical resection under one-lung ventilation anesthesia were selected as subjects and divided into the study group and the control group according to random number table method,36 patients in each group.The patients in the study group were injected with dexmedetomidine before induction of anesthesia,and the patients in the control group were injected with the same dosage of saline.The PMN counts,interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-alpha)levels were recorded and compared between the 2 groups at four time points of induction of anesthesia(T0),one-lung ventilation(T1),one-lung ventilation(T2),end of operation(T3).Oxygenation index(OI),respiratory index(RI)and PaO 2/PAO 2 were compared between the 2 groups at 4 time points.At last,the operation conditions and the application of various anesthetics were compared between the 2 groups.Results(1)The levels of PMN count,IL-6 and TNF-a at T1,T2 and T3 of the 2 groups were significantly higher than those at T0(P<0.05),and the above indexes were lower in the comparison study group than the control group(P<0.05).(2)At the time of T0 and T3,there was no significant difference in OI,RI and PaO 2/PAO 2 between the 2 groups(P>0.05).At T1 and T2,the RI of the two groups was higher than T0 and T3,OI and PaO 2/PAO 2 was lower than T0 and T3(P<0.05),and the study group was superior to the control group(P<0.05).(3)There were no significant differences in the general surgical conditions such as intraoperative blood loss,24 h urine volume,and intraoperative fluid volume between the two groups(P>0.05),but the recovery time of the study group was longer than that of the control group(P<0.05).(4)The dosage of remifentanil and propofol in the study group was lower than that of the control group(P<0.05),and the difference in the dose of cis-atracurium was not statisti cally significant(P>0.05).Conclusion Dexmedetomidine can alleviate inflammation in patients undergoing lung cancer resection,reduce the PMN count,it has certain lung protection function and is worthy of clinical application.