右美托咪定可减轻肺叶切除术中单肺通气所致肺损伤

发布时间：2018-04-06 06:37

本文选题：右美托咪定　切入点：肺叶切除术　出处：《临床麻醉学杂志》2017年12期

【摘要】：目的探讨右美托咪定对肺叶切除术中单肺通气所致肺损伤的影响。方法选择2014年5月至2017年2月拟行肺叶切除术的肺癌患者64例,男38例,女26例,年龄42~75岁,ASAⅡ或Ⅲ级。根据不同治疗方式将患者分成两组,每组32例。麻醉诱导前20min,观察组泵注右美托咪定0.5μg·kg~(-1)·h~(-1),10min后改为0.2~0.5μg·kg~(-1)·h~(-1),对照组予以等容量生理盐水。检测麻醉诱导前10min(T_0)、单肺通气即刻(T_1)、单肺通气60min(T2)、单肺通气90min(T_3)、术后24h(T_4)的全血中性粒细胞(PMN)计数,血清髓过氧化物酶(MPO)、黄嘌呤氧化酶(XOD)活性,肺内分流率(Qs/Qt),以及T_0~T_3时血管内皮生长因子(VEGF)和一氧化氮(NO)浓度。结果与T_0时比较,T_2~T_4时两组PMN计数明显增多,MPO和XOD活性明显升高(P0.05),但观察组明显低于对照组(P0.05)。与T_0时比较,T_2、T_3时两组血清VEGF浓度明显升高,但T_3时观察组明显低于对照组(P0.05)。T_2、T_3时观察组血清NO浓度明显高于对照组(P0.05)。结论右美托咪定能减少患者肺部炎症反应,减轻单肺通气所致缺血-再灌注损伤,且降低了患者机体氧化应激程度,从而对肺起到保护作用。
[Abstract]:Objective to investigate the effect of dexmetomidine on lung injury induced by single lung ventilation during lobectomy.Methods Sixty-four patients (38 males and 26 females) with lung cancer undergoing lobectomy from May 2014 to February 2017, aged 42 to 75 years, were enrolled in this study.Patients were divided into two groups according to different treatment methods, 32 cases in each group.Twenty minutes before anesthesia induction, dexmetomidine 0.5 渭 g / kg / kg / L was injected into the observation group for 10 min and then changed to 0.2 / 0. 5 渭 g / kg / kg ~ (-1) / h ~ (-1) / min, while the control group was given normal saline of the same volume.The intrapulmonary shunt rate (QS / QT) and the concentration of vascular endothelial growth factor (VEGF) and nitric oxide (no) during T_0~T_3.Results the PMN counts in the two groups were significantly higher than that at the time of T _ 0 and T _ 4, but the activities of XOD and MPO in the observation group were significantly higher than those in the control group (P _ (0.05)), but that in the observation group was significantly lower than that in the control group (P _ (0.05)).The concentration of serum VEGF in the observation group was significantly higher than that in the control group at T0, but the concentration of no in the observation group was significantly lower than that in the control group at the time of T _ 2 / T _ 3. The serum no concentration in the observation group was significantly higher than that in the control group (P 0.05).Conclusion dexmetomidine can reduce pulmonary inflammation, reduce ischemia reperfusion injury induced by single lung ventilation, and reduce the degree of oxidative stress in patients, so it can protect the lung.
【作者单位】：南通大学附属医院麻醉科;
【分类号】：R614

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