右美托咪定联合地塞米松对单肺通气手术患者的肺保护作用

发布时间：2018-01-19 16:01

本文关键词： 单肺通气肺损伤肺保护右美托咪定地塞米松麻醉　出处：《重庆医学》2015年34期 　论文类型：期刊论文

【摘要】：目的研究右美托咪定联合地塞米松对单肺通气(OLV)手术患者的肺保护作用。方法选取2010年8月至2014年9月在该院行食管癌根治术患者96例,随机分为对照组、右美托咪定组(DEX组)和右美托咪定加地塞米松组(联合组),每组32例。3组患者均采用全凭静脉麻醉,术中行OLV,于麻醉诱导前5min(T0)、OLV 30min(T1)、OLV 60min(T2)、OLV 90min(T3)、OLV 120min(T4)、恢复双肺通气(TLV)30 min(T5)检测3组患者血清中的白介素IL-1β、IL-10以及肿瘤坏死因子α(TNF-α)水平变化。比较各组患者术中肺脏组织标本匀浆中戊二醛(MDA)、髓过氧化物酶(MPO)、黄嘌呤氧化酶(XOD)水平变化,并记录3组患者机械通气时间、OLV时间、手术时间、总失血量、总输液量、术后感染率和住院天数。结果 OLV后各组患者血清IL-1β、IL-10、TNF-α均呈显著升高趋势(P0.05),60min后DEX组、联合组血清IL-1β、TNF-α均低于对照组,90min后DEX组、联合组血清IL-10水平显著高于对照组(P0.05),与DEX组比较,联合组在T3后显著高于DEX组(P0.05);与对照组比较,DEX组、联合组肺组织匀浆中MDA、MPO、XOD水平均显著低于对照组(P0.05);与DEX组比较,联合组在T3后显著低于DEX组(P0.05)。对照组术后出现3例肺感染,DEX组有1例感染,而联合组未出现术后感染病例。对照组平均住院天数最长(16d),DEX组比对照组短2d,而联合组平均住院天数比DEX组短1d,虽然差异无统计学意义,但具有很好临床意义。结论右美托咪定用于全身麻醉OLV术中具有肺保护作用,而右美托咪定联合地塞米松在OLV对单肺通气手术患者具有更好的肺保护作用,可使肺组织炎症和氧化应激反应程度都显著降低。
[Abstract]:Objective to study the effects of dexmetidine combined with dexamethasone on single lung ventilation (OLVV). Methods 96 patients with esophageal cancer underwent radical resection from August 2010 to September 2014. They were randomly divided into control group, dexmetidine group (DEX group) and dexamethasone plus dexamethasone group (Dexamethasone group). 32 patients in each group were treated with total intravenous anesthesia. OLV was performed during the operation. Before anesthesia induction, OLV 30 mins T1 + OLV 60 min T2 + OLV 90 min T3). The serum levels of interleukin IL-1 尾 in the three groups were detected by OLV 120 min, T4 and T5. The levels of IL-10 and TNF- 伪 were compared in the lung tissue homogenate of each group during operation, and the contents of malondialdehyde (MDA) and myeloperoxidase (MPO) in the homogenate of lung tissue were compared. The changes of XODs in xanthine oxidase were recorded, and the time of mechanical ventilation and OLV, operation time, total blood loss and total infusion volume were recorded in the three groups. Results after OLV, the serum IL-1 尾 -IL-10 TNF- 伪 increased significantly in the DEX group. The level of serum IL-1 尾 -TNF- 伪 in the combined group was significantly higher than that in the control group (P 0.05), compared with that in the DEX group. After T3, the combined group was significantly higher than the DEX group (P 0.05). Compared with the control group, the level of MDA-MPOOX XOD in the lung homogenate of the combined group was significantly lower than that in the control group (P 0.05). Compared with DEX group, the combined group was significantly lower than that of DEX group after T3 (P 0.05). In the control group, there were 3 cases of pulmonary infection and 1 case of infection in DEX group after operation. The average hospitalization days in the control group were 2 days shorter than those in the control group, while the average hospitalization days in the combined group were 1 day shorter than that in the DEX group. Although the difference is not statistically significant, it has good clinical significance. Conclusion dexmetomidine has lung protection effect in general anesthesia OLV. Dexamethasone combined with dexamethasone has a better lung protective effect on patients undergoing single lung ventilation and can significantly reduce the degree of inflammation and oxidative stress in lung tissue.
【作者单位】：中国人民解放军第175医院麻醉科;
【分类号】：R614
【正文快照】： 单肺通气(one lung ventilation,OLV)技术可使手术侧肺萎缩,有利于明确病变范围,为开胸手术创造了良好条件。目前,已广泛应用于胸部外科手术,如食管癌、肺脓肿、肺叶切除、全肺切除、胸主动脉瘤等。然而,OLV可以引起一系列的病理、生理改变,如肺萎缩(复张)、肺内分流率(Qs/Qt)

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