右美托咪定联合单肺通气保护策略对肺叶切除术患者免疫功能及肺损伤的影响

Effects of Dexmedetomidine Combined with One-lung Ventilation Protection Strategy on Immune Function and Lung Injury in Patients with Pulmonary Lobectomy

目的:探讨右美托咪定联合单肺通气保护策略对肺叶切除术患者免疫功能及肺损伤的影响。方法:选取江西省胸科医院2020年1月—2022年12月收治的100例行肺叶切除术的肺癌患者纳入研究,随机分为对照组与观察组,各50例。两组均采用单肺通气保护策略,观察组在此基础上联合使用右美托咪定。对比两组手术情况,麻醉诱导前10 min(T0)、单肺通气后10 min(T_(1))、单肺通气1 h(T_(2))、手术结束时(T_(3))的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、氧化应激指标、血清炎症指标,缺血-再灌注损伤指标,免疫功能指标。结果:两组手术时间、单肺通气时间、术中输液量、术中出血量、苏醒时间比较,差异均无统计学意义(P>0.05);观察组T_(1)、T_(2)、T_(3)的MAP、HR均较对照组低,差异均有统计学意义(P<0.05);观察组T_(1)、T_(2)、T_(3)的血清超氧化物歧化酶(superoxide dismutase,SOD)水平均较对照组高,血清丙二醛(malondialdehyde,MDA)水平均较对照组低,差异均有统计学意义(P<0.05);观察组T_(2)、T_(3)的血清γ干扰素(interferon-γ,IFN-γ)、白细胞介素-10(interleukin-10,IL-10)水平均较对照组低,差异均有统计学意义(P<0.05);观察组T_(3)的血清血管内皮生长因子(vascular endothelial growth factor,VEGF)、缺氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)水平均低于对照组,差异均有统计学意义(P<0.05);观察组T_(3)的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组,差异均有统计学意义(P<0.05)。结论:右美托咪定联合单肺通气保护策略有利于维持患者术中血流动力学稳定,可降低氧化应激反应及炎症反应,减轻单肺通气所致的缺血-再灌注损伤,且对免疫功能的影响较小。

Objective:To explore the effects of Dexmedetomidine combined with one-lung ventilation protection strategy on immune function and lung injury in patients with pulmonary lobectomy.Method:A total of 100 patients with lung cancer who underwent lung lobectomy in Jiangxi Provincial Chest Hospital from January 2020 to December 2022 were enrolled in the study and were randomly divided into control group and observation group,with 50 cases in each group.Both groups were treated with one-lung ventilation protection strategy,and the observation group was additionally given Dexmedetomidine on this basis.The operative conditions,mean arterial pressure(MAP),heart rate(HR),oxidative stress index and serum inflammation index were determined 10 min before anesthesia induction(T0),10 min after single lung ventilation(T_(1)),1 h after single lung ventilation(T_(2))and after operation(T_(3)),ischemia-reperfusion injury indicators and immune function indicators were compared between the two groups.Result:There were no significant differences in operation time,single lung ventilation time,intraoperative infusion volume,intraoperative blood loss and recovery time between the two groups(P>0.05).The MAP and HR at T_(1),T_(2)and T_(3)in observation group were lower than those in control group,the differences were statistically significant(P<0.05).The levels of serum superoxide dismutase(SOD)at T_(1),T_(2)and T_(3)in observation group were higher than those in control group,while the levels of serum malondialdehyde(MDA)were lower than those in control group,the differences were statistically significant(P<0.05).The levels of serum interferon-γ(IFN-γ)and interleukin-10(IL-10)at T_(2)and T_(3)in observation group were lower than those in control group,the differences were statistically significant(P<0.05).Serum levels of vascular endothelial growth factor(VEGF)and hypoxia-inducing factor-1α(HIF-1α)at T_(3)in observation group were lower than those in control group,the differences were statistically significant(P<0.05).The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)at T_(3)in observation group were higher than those in control group,the differences were statistically significant(P<0.05).Conclusion:Dexmedetomidine combined with one-lung ventilation protection strategy is beneficial to maintaining the stability of intraoperative hemodynamics,and it can reduce the oxidative stress response and inflammatory response,and alleviate the ischemia-reperfusion injury caused by one-lung ventilation,and it has small influence on immune function.