不同剂量右美托咪定联合乌司他丁在尘肺大容量肺灌洗手术治疗患者中的应用效果

Application effect of different doses of dexmedetomidine combined with ulinastatin in patients with pneumoconiosis and large-volume lung lavage surgery

目的探究不同剂量右美托咪定联合乌司他丁在尘肺大容量肺灌洗手术(WLL)治疗患者中的应用效果。方法选择广州市第十二人民医院2019年1月至2020年6月收治的60例尘肺WLL治疗患者作为研究对象,根据随机数字表法将其分为观察组、对照组两组,各30例。对照组给予0.5μg/kg剂量的右美托咪定,并联合乌司他丁用于WLL,观察组给予1.0μg/kg剂量的右美托咪定,并联合乌司他丁用于WLL。评估手术前、术后1周患者的血气分析指标[血氧分压(PaO_(2))及动脉血氧饱和度(SaO_(2))],比较不同时间点[麻醉诱导前(T_(0)),肺灌洗结束(T_(1)),气管导管拔出后(T_(2))]患者静脉血肿瘤坏死因子(TNF-α)、白介素6(IL-6)、白介素10(IL-10)水平,同时比较患者术后12、24、36、48 h的第1秒用力呼气容积(FEV1)、肺活量(FVC)变化情况。结果术前,两组尘肺患者PaO_(2)水平及SaO_(2)水平比较,无明显差异(P>0.05),术后1周,两组患者PaO_(2)及SaO_(2)水平均升高,且观察组PaO_(2)及SaO_(2)水平高于对照组(P<0.05);两组患者在T_(0)时IL-6、IL-10、TNF-α的水平比较差异无统计学意义(P>0.05);两组患者在T_(1)、T_(2)时检测IL-6、IL-10、TNF-α的水平均升高,但观察组T_(1)、T_(2)时的IL-6、TNF-α水平低于对照组,IL-10水平高于对照组(P<0.05);两组患者术后24、36、48 h的FVC、FEV1值均高于术后12h的FVC、FEV1值,且术后24、36、48 h观察组FVC、FEV1均高于对照组(P<0.05)。结论与常规0.5μg/kg剂量比较,术前采用1.0μg/kg右美托咪定联合乌司他丁治疗尘肺患者WLL效果明确,能改善血气分析指标、血清炎性因子水平及肺部功能。

Objective To explore the effect of different doses of dexmedetomidine combined with ulinastatin in the treatment of patients with pneumoconiosis mass lung lavage(WLL).Methods The 60 patients with pneumoconiosis WLL treated in Guangzhou Twelfth People's Hospital from January 2019 to June 2020 were selected as the research objects.According to the random number table method,they were divided into two groups,30 cases in the observation group and 30 cases in the control group.The control group was given dexmedetomidine at a dose of 0.5μg/kg and combined with Ulinastatin for WLL.The observation group was given dexmedetomidine at a dose of 1.0μg/kg,combined with ulinastatin for WLL.To evaluate the blood gas analysis indexes[partial pressure of blood oxygen(PaO_(2))and arterial blood oxygen saturation(SaO_(2))]before and 1 week after surgery.Compare different time points[before induction of anesthesia(T_(0)),end of lung lavage(T_(1)),after tracheal tube removal(T_(2))]patient venous blood tumor necrosis factor(TNF-α),interleukin 6(IL-6),interleukin 10(IL-10)level.At the same time,the changes of forced expiratory volume(FEV1)and vital capacity(FVC)in the first second at 12,24,36,and 48 hours after operation were compared.Results Before operation,there was no significant difference in PaO_(2) and SaO_(2) levels between the two groups of pneumoconiosis patients(P>0.05).One week after operation,the PaO_(2) and SaO_(2) levels of the two groups increased,and the PaO_(2) and SaO_(2) levels of the observation group were higher than those of the control group(P<0.05).There was no significant difference in the levels of IL-6,IL-10 and TNF-αbetween the two groups of patients at T_(0)(P>0.05).The levels of IL-6,IL-10,and TNF-αin the two groups of patients increased at T_(1) and T_(2),but the levels of IL-6 and TNF-αin the observation group at T_(1) and T_(2) were lower than those in the control group.The level of IL-10 was higher than that of the control group(P<0.05).The FVC and FEV1 values of the two groups of patients at 24,36,and 48 hours after the operation were higher than the FVC and FEV1 values at the 12 hours after the operation,and the FVC and FEV1 of the observation group were higher than those of the control group at 24,36,and 48 hours after the operation(P<0.05).Conclusion Compared with the conventional dose of 0.5μg/kg,preoperative use of 1.0μg/kg dexmedetomidine combined with ulinastatin in the treatment of wll in pneumoconiosis patients has a clear effect,can improve blood gas analysis indicators,serum inflammatory factor levels and lung function,and is worthy of clinical application.