右美托咪定复合帕瑞昔布钠在开胸手术中单肺通气时的肺保护作用

目的 评价右美托咪定复合帕瑞昔布钠在开胸手术患者单肺通气时的肺保护作用。方法 择期行食管或肺癌根治手术患者 80 例， 性别不限， 年龄 45~70 岁， ASA 分级Ⅰ~Ⅱ级， 随机分为右美托咪定组 （D 组）、 帕瑞昔布钠组 （P 组）、 右美托咪定复合帕瑞昔布钠组 （DP 组） 及对照组 （C 组）， D 组于麻醉诱导前 10 min 内右美托咪定静脉输注 1 μg/kg， 后以 0.6 μg·kg-1 ·h-1 输注至关胸， P 组诱导前 10 min 静脉给予帕瑞昔布钠 40 mg， DP 组患者采用右美托咪定静脉输注 （同 D 组） 及帕瑞昔布钠 40 mg 静脉注射， C 组给予等体积生理盐水。于麻醉诱导后即刻 （T1)、 单肺通气 30 min （T2 ）、 60 min （T3 ） 及术毕 （T4 ） 分别采集动脉血， 行动脉血气分析， 计算氧合指数 （OI）， 并采用酶联免疫吸附试验 （ELISA） 法测定血清肿瘤坏死因子 （TNF） -α、 白细胞介素 （IL） -6 及 IL-8 水平。结果 除 DP 组 T2 时点与 T1 时点 IL-8 水平无明显差异外， 各组 T2~4 时点与 T1 时点比较， TNF-α、 IL-6、 IL-8 水平均升高， OI 降低 （P<0.05）； 与 C 组比较， T2~4 时点 D 组、 P 组、 DP 组 TNF-α、 IL-6、 IL-8 水平降低， 而 OI 升高 （P < 0.05）， D 组、 P 组各时点比较差异无统计学意义， DP 组 T2~4 时点 TNF-α、 IL-6、 IL-8 水平低于 D 组、 P 组， OI 高于 D 组、 P 组 （P < 0.05）。结论 右美托咪定复合帕瑞昔布钠可进一步减轻开胸手术单肺通气期间炎性因子的水平、 改善肺氧合， 显示更好的肺保护作用。

The pulmonary protection of dexmedetomidine in combination with parecoxib in patients undergoing thoracotomy during one-lung ventilation

Objective To evaluate the pulmonary protection of dexmedetomidine in combination with parecoxib in pa? tients undergoing thoracotomy with one-lung ventilation. Methods Eighty patients undergoing elective resection of esopha? geal or lung cancer, including both sex, aged 40-70 yr, ASAⅠ-Ⅲ, were randomly divided into four groups (n=20), dexme? detomidine group (D group), parecoxib group (P group), dexmedetomidine in combination with parecoxib group (DP group) and control group (C group). Dexmedetomidine 1 μg/kg was infused in ten minutes and then continued infusion at the rate 0.6 μg·kg-1 ·h-1 until the chest was closed in group D. Parecoxib 40 mg was infused 10 min before the induction of anesthesia in group P. DP group was given parecoxib 40 mg and parecoxib 40 mg 10 min before the induction of anesthesia. The equal volume of normal saline was given in group C. Blood samples were collected for determination of blood gas analysis and the serum concentration of tumor necrosis factor (TNF) -α, interleukin (IL)-6 and IL-8 immediately after the induction of anes? thesia (T1), 30 min (T2) and 60 min(T3) after one-lung ventilation, and at the end of the operation (T4). Oxygenation index (OI) was calculated. The serum levels of TNF-α, IL-6 and IL-8 were detected by ELISA. Results Compared with time T0, the serum concentrations of TNF-α, IL-6 and IL-8 (except IL-8 at the time T2 in DP group) were significantly increased, and OI was decreased in all groups at the time T2-4 (P < 0.05). Compared with group C, concentrations of TNF-α, IL-6 and IL-8 decreased and OI increased significantly at the time T2-4 in D group, P group and DP group (P < 0.05). There were no obvious differences in concentrations of TNF-α, IL-6, IL-8 and OI value between D group and P group (P > 0.05). Conclusion Combination of dexmedetomidine and parecoxib can further mitigate inflammatory response, improve lung oxygenation dur? ing one-lung ventilation, and provide pulmonary protection in patients undergoing thoracotomy.