右美托咪定对大面积烧伤手术患者肺氧合和炎性反应的影响

Effects of dexmedetomidine on pulmonary oxygenation and inflammatory response in patients undergoing surgery for extensive burns

目的探讨右美托咪定对大面积烧伤手术患者肺氧合和炎性反应的影响。方法选择大面积烧伤切痂植皮手术患者40例,年龄20~60岁,ASA分级Ⅱ~Ⅲ级,烧伤总面积>30%,或Ⅲ度烧伤面积>20%,采用数字表法随机将患者分为右美托咪定组(Y组)和对照组(D组),每组20例。右美托咪定组麻醉诱导前静脉泵入右美托咪定0.5μg/kg,10 min泵入,然后以0.4μg·kg^(-1)·h^(-1)的输注速度至手术结束前10 min。对照组静脉泵入等量的0.9%氯化钠溶液。比较右美托咪定给药前(T0)、手术开始后1 h(T1),手术开始后2 h(T2),右美托咪定停药时(T3)的氧合指数(OI),肺泡动脉氧分压差(A-aDO_(2)),血浆肿瘤坏死因子(TNF-α)和白细胞介素-6(IL-6)浓度。结果组间比较,在T1、T2、T3时Y组OI明显高于D组(P<0.05),A-aDO_(2),TNF-α和IL-6浓度明显低于D组(P<0.05)。结论右美托咪定可改善大面积烧伤手术患者肺氧合功能,减少炎性反应,具有肺保护作用。

Objective To investigate the effect of dexmedetomidine on pulmonary oxygenation and inflammatory response in patients undergoing surgery for extensive burn.Methods A total of 40 patients with extensive burns who underwent escharectomy and skin grafting were selected.They were aged 20~60 years old with ASA gradeⅡ~Ⅲ,and the total burn area was over 30%,with the burn area of gradeⅡ~Ⅲover 20%.The patients were divided into dexmedetomidine group(group Y,n=20)and control group(group D,n=20)according to random number table method.In group Y,dexmedetomidine 0.5μg/kg was injected intravenously for 10 min before induction of anesthesia,and then the infusion rate was kept at 0.4μg·kg^(-1)·h^(-1) until 10 min before the end of the surgery.In group D,an equal amount of 0.9%sodium chloride solution was injected intravenously.The oxygenation index alveolar-arterial oxygen partial pressure difference(PA-aDO2),plasma tumor necrosis factor(TNF-α)and interleukin-6(IL-6)concentrations before dexmedetomidine administration(T0),at 1h after surgery(T1),at 2h after surgery(T2),and at the time of dexmedetomidine withdrawal(T3)were compared.Results The results showed that the OI in group Y was significantly higher than that in group D at T1,T2,and T3(P<0.05),and the levels of PA-aDO2,TNF-αand IL-6 in group Y were significantly lower than those in group D(P<0.05).Conclusion Dexmedetomidine can improve pulmonary oxygenation function,and reduce inflammatory response in patients undergoing surgery for extensive burn,which has a protective effect on the lungs.