肺保护通气与右美托咪定联合应用对胸腔镜下心脏手术患者的肺保护效果

Effect of lung-protective ventilation combined with dexmedetomidine on lung protection in patients undergoing thoracoscopic heart surgery

目的探讨在胸腔镜下心脏手术中联合使用肺保护通气策略与右美托咪定(Dex)的肺保护效果。方法将符合标准的60例胸腔镜下心脏手术患者随机均分为四组(15例/组):肺保护性机械通气策略组(A组)、使用Dex组(B组)、联合应用Dex+肺保护性机械通气策略(C组)、空白对照组(D组)。四组患者于麻醉诱导前(T0)、单肺通气前即刻(T1)、单肺通气30 min(T2)、恢复双肺通气前即刻(T3)、恢复双肺通气15 min(T4)、手术结束后(T5)、术后2 h(T6)时间点记录气道峰压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw);记录T0、T1、T2、T3、T4、T5、T6的血气分析计算氧合指数(OI)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、丙二醛(MDA)的浓度。结果①与D组比较,其余三组患者Ppeak、Pplat、Raw于相应时间点均有降低,差异有统计学意义;②C组其相应时间点OI优于其他三组;③C组的相应时间点TNF-α、IL-6、MDA值与其他三组比较均降低。结论在胸腔镜下心脏手术中实施肺保护通气策略和单独使用Dex均有肺保护作用,而两种方法联合使用具有协同肺保护作用。

Objective To discuss the effect of lung-protective ventilation combined with dexmedetomidine on lung protection in patients undergoing thoracoscopic heart surgery.Methods 60 patients who met the criteria were randomly divided into four groups:lung-protective mechanical ventilation group(group A,n=15),dexmedetomidine group(group B,n=15),lung-protective mechanical ventilation combined with dexmedetomidine group(group C,n=15)and blank control group(group D,n=4).Peak airway pressure(Ppeak),airway plateau pressure(Pplat)and airway resistance(Raw)were recorded at time points of before anesthesia induction(T0),immediately before one-lung ventilation(T1),30 min after one-lung ventilation(T2),immediately before recovery of two-lung ventilation(T3),15 min after recovery of two-lung ventilation(T4),after the operation(T5)and 2 h after the operation(T6),respectively.The blood gas analysis of T0,T1,T2,T3,T4,T5 and T6 was recorded,the oxygenation index(OI)and the concentrations of tumor necrosis factor-α(TNF-α)、interleukin-6(IL-6)and malondialdehyde(MDA)were calculated.Results Compared with group D,Ppeak,Pplat and Raw of the other three groups were significantly lower at relevant time points.The OI of group C was better than that of the other three groups at the corresponding time points.The levels of TNF-α,IL-6 and MDA in group C were lower than those in the other three groups.Conclusion In thoracoscopic heart surgery,lung-protective ventilation strategy and DEX have lung protective effects,and the combination of the two methods has a synergistic effect.