右美托咪定对食管癌根治术单肺通气患者血清炎性反应的影响

目的观察右美托咪定对食管癌根治术中单肺通气患者围术期血清炎性反应的影响。方法选取择期全麻下行食管癌根治术患者72例,男36例,女36例,年龄48~70岁,ASAⅠ或Ⅱ级,并用随机数字表法将患者均分为两组。D组于麻醉前静脉泵入右美托咪定0.5μg/kg,15min输注完后进行静脉诱导,随后按0.3μg·kg~(-1)·h~(-1)术中泵入,至手术结束前40min改为0.6μg/kg,泵入10min后停药。C组泵注等量生理盐水。两组静脉诱导完善后予左侧双腔支气管插管后机械通气,纤维支气管镜定位。在诱导前10min(T_0)、单肺通气后60min(T_1)、双肺通气30min(T_2)及术后120min(T_3)采集桡动脉血样检测血清TNF-α、IL-6、IL~(-1)0、巨噬细胞炎性蛋白-2(MIP-2)及人肺表面活性特异蛋白(SP-D)的水平。观察术中单肺通气时间、失血量、补液量、尿量及术后复苏室停留时间、呼吸机使用时间和苏醒期躁动、低氧血症、肺部炎症等不良反应的发生情况。结果与T_0时比较,T_1~T_3时两组血清TNF-α、IL-6、IL~(-1)0、MIP-2及SP-D浓度均明显升高(P0.05)。T_1~T_3时D组血清TNF-α、IL-6和SP-D浓度明显低于C组(P0.05),两组IL~(-1)0和MIP-2浓度差异无统计学意义。D组术后复苏室停留时间、呼吸机使用时间和苏醒期躁动、低氧血症、肺部炎症等不良反应的发生率明显低于C组(P0.05)。结论右美托咪定可通过抑制炎症反应减轻食管癌根治术单肺通气的围术期血清炎性反应,缩短复苏室停留时间、呼吸机使用时间和苏醒期躁动、低氧血症、肺部炎症等不良反应的发生率。

Effect of dexmedetomidine in patients with radical resection of one-lung ventilation on serum inflammato-ry response of esophageal cancer

Objective To observe the effect of dexmedetomidine during esophageal cancer sur-gery on serum inflammatory response in patients undergoing one-lung ventilation.Methods Seventy-two patients undergoing general anesthesia for esophageal cancer radical operation,male 36 cases,fe-male 36 cases,aged 48-70 years,ASA Ⅰ or Ⅱ.Patients were randomly divided into two groups,36 cases in each .group D received intravenous infusion of dexmedetomidine of 0.5 μg/kg before for an-esthesia,1 5 min followed by intravenous induction of 0.3 μg·kg-1 ·h-1 in the pump,till 40 min to-ward the end of the operation 0.6 μg/kg 10 min before drug withdrawal.Group C was infused the same amount of normal saline.After intravenous induction left double lumen bronchial intubation me-chanical ventilation,fiberbronchoscopy positioning were performed.The levels of serum tumor necro-sis TNF-α,IL-6,IL-10,macrophage inflammatory protein-2 (MIP-2)and surfactant protein D human (SP-D)were monitored in the serum at four time points:10 min before induction (T0 ),60 min after single lung ventilation (T1 ),30 min after two lung ventilation (T2 )and 120 min after surgery (T3 ). Observation of one-lung ventilation time,blood loss,rehydration,urine and postoperative recovery time,time using breathing machine,agitation during the period of awakening,hypoxemia,lung in-flammation,the incidence of adverse reactions.Results Compared with T0 ,in two groups of patients at T1-T3 ,serum TNF-α,IL-6,IL-10,MIP-2 and SP-D concentrations were significantly higher(P <0.05).Compared with group C,in group D at T1-T3 ,serum TNF-α,IL-6 and SP-D concentration significantly decreased (P <0.05),but there was no difference between MIP-2 and IL-10.Compared with group C,group D has less postoperative recovery room residence time,machine ventilation time,agitation period of awakening,hypoxemia,lung inflammation,incidence of adverse reactions (P<0.05).Conclusion Dexmedetomidine can inhibit inflammatory reaction in radical operation of one-lung ventilation esophageal cancer,reduce recovery room stay and the time of using,breathing machine use time,agitation during awakening period,the incidence of hypoxemia,lung inflammation.