右美托咪定对老年患者胸腔镜肺癌根治术后肺部并发症及炎症反应的影响

Effect of dexmedetomidine on pulmonary complications and inflammatory response after thoracoscopic radical resection of lung cancer in elderly patients

目的:探究右美托咪定对老年患者胸腔镜肺癌根治术后肺部并发症及炎症反应的影响。方法:选取2019年8月至2021年8月邯郸市中心医院收治的110例老年肺癌患者为研究对象,按随机数字表法随机分为对照组(n=55)与观察组(n=55)。观察组在麻醉诱导前10 min静脉注射右美托咪定1.0μg/kg,并以0.3μg/(kg·h)泵注至术毕;对照组予以等量生理盐水。比较两组术中情况、血气分析指标[氧合指数(oxygenation index,OI)、肺内分流率(intrapulmonar y shunt rate,Qs/Qt)]、肺部并发症及血清白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis f ac tor-α,TNF-α)水平。结果:两组手术时间、麻醉时间、单肺通气时间、输液量、输血量等术中一般情况比较差异均无统计学意义(均P>0.05)。与对照组相比,观察组在单肺通气30 min(T_(2))、单肺通气60 min(T_(3))、恢复双肺通气15 min(T_(4))时刻的OI均明显更高,Qs/Qt均明显更低(均P<0.05)。观察组术后肺部并发症总发生率明显低于对照组(16.36%vs 32.73%,P<0.05)。观察组T_(3)和术后2 h(T_(5))、术后24h(T_(6))时刻血清IL-6、TNF-α水平均明显低于对照组(均P<0.05)。结论:右美托咪定可有效改善老年患者胸腔镜肺癌根治术中的血氧状态,减轻炎症反应,从而降低术后肺部并发症发生率。

Objective:To investigate the effect of dexmedetomidine on pulmonary complications and inflammatory response after thoracoscopic radical resection of lung cancer in elderly patients.Methods:A total of 110 elderly patients with lung cancer admitted to Handan Central Hospital from August 2019 to August 2021 were selected as the study subjects.They were randomly divided into a control group and an observation group according to the random number table method,each group with 55 cases.In the observation group,1.0 mg/kg dexmedetomidine was intravenously injected 10 min before anesthesia induction,and 0.3 mg/(kg·h)was pumped to the end of operation.The control group was given the same amount of saline.The intraoperative conditions,blood gas analysis indexes[oxygenation index(OI),intrapulmonary shunt rate(Qs/Qt)],pulmonary complications,and serum inflammatory factors[interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)]were compared between the 2 groups.Results:There was no statistically significant difference in the operation time,anesthesia time,one-lung ventilation time,transfusion volume,blood transfusion volume between the 2 groups(all P>0.05).Compared with the control group,the OI at 30 min(T_(2)),60 min(T_(3))of single lung ventilation and recovery of bilateral lung ventilation for 15 min(T_(4))in the observation group was significantly higher,and Qs/Qt was significantly lower(all P<0.05).The total incidence of postoperative pulmonary complications in the observation group was significantly lower than that in the control group(16.36%vs 32.73%,P<0.05).The serum IL-6 and TNF-αlevels at T_(3),and 2 h(T_(5)),24 h(T_(6))after the operation in the observation group were significantly lower than those in the control group(all P<0.05).Conclusion:Dexmedetomidine can effectively improve the blood oxygen status and reduce the inflammatory response in elderly patients undergoing thoracoscopic radical resection of lung cancer,thereby reducing the incidence of postoperative pulmonary complications.