地塞米松复合罗哌卡因对胸腔镜手术后患者血流动力、应激状态及心肌功能的保护作用

Analysis of protective effect of dexamethasone combined with ropivacaine on hemodynamics,stress state and myocardial function in patients after thoracoscopic surgery

目的 探讨地塞米松(DXMS)复合罗哌卡因(ROP)对胸腔镜手术术后患者血流动力、应激状态及心肌功能的保护效果。方法 收集2019年8月—2021年2月我院接受微创胸腔镜手术的患者共64例进行前瞻性非随机对照实验,其中28例患者手术时使用ROP麻醉为对照组;另36例患者手术时使用了DXMS复合ROP麻醉为观察组。比较两组的生命体征[平均动脉压(MAP)、心率(HR)]、血流动力指标[血氧饱和度(SpO_(2))、氧合指数(OI)、血氧分压(PaO_(2))]、血浆肾上腺素(E)、去甲肾上腺素(NE)水平、炎症因子水平[巨噬细胞炎性蛋白I(MIP-1)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)]、心肌损伤标志物[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)]及心脏脂肪酸结合蛋白(H-FABP)水平,并统计术后不良反应发生率。结果 观察组MAP及HR变化波动均小于对照组(P<0.05);麻醉后、插管后、拔管时观察组SpO_(2)、OI、PaO_(2)水平均高于对照组(P<0.05);在手术过程中,两组的E、NE及MIP-1、IL-6、TNF-α逐渐升高,但观察组均低于对照组(P<0.05)。术后,两组CK-MB、cTnI及H-FABP水平降低,且观察组更低于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论 DXMS复合ROP可有效降低开胸手术术后患者的心肌损伤、炎症因子与应激状态,并可有效改善血流动力,可在临床推广使用。

Objective To explore the protective effect of Dexamethasone(DXMS)combined with Ropivacaine(ROP)on hemodynamics,stress state and myocardial function in patients after thoracoscopic surgery.Methods A total of 64 patients who underwent minimally invasive thoracoscopic thoracotomy in our hospital were collected for prospective non-randomized controlled experiments.28 patients were treated with ROP anesthesia during the operation and were regarded as the control group.The other 36 patients were treated with DXMS combined with ROP anesthesia during the operation regarded as a study group.The vital signs,hemodynamic markers,plasma epinephrine(E),norepinephrine(NE)levels,inflammatory factor levels,myocardial injury markers,cardiac fatty acid-binding protein levels in the two groups were observed,and the occurrence of postoperative adverse reactions was counted.Results The fluctuations of Mean arterial pressure(MAP)and Heart rate(HR)in the study group were lower than those in the control group(P<0.05).The levels of Peripheral capillary oxygen saturation(SpO_(2)),Oxygenation index(OI)and Pressure of oxygen(PaO_(2))in the study group were higher than those in the control group after anesthesia,after intubation,and during extubation(P<0.05).During the process,the levels of E,NE,Macrophage inflammatory protein I(MIP-1),Interleukin-6(IL-6)and Tumor necrosis factor alpha(TNF-α)in the two groups gradually increased,but the research group was lower than the control group(P<0.05).After operation,the levels of Creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI)and Heart type-Fatty acid binding protein(H-FABP)in the two groups were decreased,and the research group was lower than the control group(P<0.05).Finally,there was no difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion DXMS combined with ROP can effectively reduce myocardial injury,inflammatory factors and stress state in patients after thoracotomy,and can effectively improve hemodynamics,which is worthy of clinical promotion.