右美托咪啶对单肺通气麻醉患者肺缺血-再灌注的影响  

The effect of dexmedetomidine on ischemia-reperfusion injury in patients undergoing one lung ventilation

作　　者：李雅楠[1] 石翊飒[1] 张荣智[1] 李爱梅[1] 韩杰[1] 

机构地区：[1]兰州大学第二医院麻醉科,甘肃兰州730030

出　　处：《中国现代医药杂志》2013年第3期23-26,共4页Modern Medicine Journal of China

摘　　要：目的观察右美托咪啶对食管癌手术患者单肺通气(OLV)时肺缺血-再灌注的影响。方法选择30例择期食管癌根治手术患者,性别不限,年龄48～75岁,体重45～75kg,ASA分级Ⅰ或Ⅱ级。采用随机数字表法,随机分为2组,右美托咪啶组(A组,n=15),对照组(B组,n=15)。常规诱导前,A组经10min静脉输注右美托咪啶1μg/kg,后恒速静脉输注0.5μg.kg-1.h-1至术毕前30min;B组采用同样方法静脉输注等容量生理盐水,两组都用异丙酚和瑞芬太尼维持麻醉。分别于诱导前(T0)、OLV即刻(T1)、OLV60min(T2)、OLV120min(T3)、膨肺后1h(T4)、术后24h(T5)采集静脉血样,行全血中性粒细胞(PMN)计数,测定血清髓过氧化物酶(MPO)、黄嘌呤氧化酶(XOD)含量。结果与T0比较,两组PMN计数在T2～T5明显升高(P<0.05)。与A组比较,B组T2～T5时中性粒细胞计数升高明显。与T0时比较,两组MPO、XOD浓度在T2～T5明显增高(P<0.05);与B组比较,A组T2～T5时血清MPO、XOD浓度明显降低(P<0.05)。结论右美托咪啶减少单肺通气患者血XOD、MPO活性和PMN计数的升高,可对单肺通气时肺缺血-再灌注损伤起保护作用。Objective To investigate the effect of dexmedetomidine on ischemia-reperfusion injury in patients who had esophageal cancer undergoing one lung ventilation （OLV）. Methods Thirty ASA I or II patients aged 48-75years,weighting 50~78kg underwent esophagectomy were randomly divided into two groups （n=15 each）： Dexmedetomidine group （A group）, control group （B group）. Before anesthsia induction, the group A with using intravenous infusion method was injected 1μg/kg dose of dexmedetomidine for 10min,and then was injected at rate of 0.5μg. kg-1. h-1 until 30min before operation. The same volume of normal saline was given in group B. Anesthesia with propofol and remifentanil. Central venous blood samples were taken before anesthesia（T0）, immediately befroe OLV（T1）, 60min after OLV （T2）, 120 min after OLV （T3）, lh after lung inflate （T4）, 24 hours after operation （T5） for the measurements of xanthine oxidase （XOD） and myeloperoxidase（MPO） activity. The count of PMN was performed as well. Results The count of PMN was significantly higher at T2-T5 than that at To in both groups（P〈 0.05）. Compared with group B,the counts of PMN were significant decreased at T2-T5 in group A （P〈0.05）. Compared with To, serum XOD and MPO concentration were significantly increased at T2-T5 （P〈0.05）. Compared with group B, the indexes mentioned above were signifieiantly decreased at T2-T5 in group A （P〈0.05）. Conclusion Dcxmedetomidine may protect the lung from ischemiareferfusion injury in patients undergoing OLV through decreasing the activity of plasma XOD and MPO, reducing the count of PMN. [

关 键 词：单肺通气 盐酸右美托咪啶 肺缺血-再灌注 

分 类 号：R614[医药卫生—麻醉学]