远隔缺血预处理联合右美托咪定对开胸手术患者单肺通气时肺损伤的影响  

Effect of remote ischemic preconditioning combined with dexmedetomidine on lung injury during one-lung ventilation in patients undergoing thoracic surgery

作　　者：路建[1] 肖旺频[1] 周红梅[1] 周清河[1] 赵烨钧[1] 沈颖彦[1] 

机构地区：[1]嘉兴学院附属第二医院麻醉科,314000

出　　处：《中华麻醉学杂志》2014年第11期1297-1299,共3页Chinese Journal of Anesthesiology

基　　金：浙江省医学会临床科研基金项目（2012 ZYC-A63）

摘　　要：目的 探讨远隔缺血预处理联合右美托咪定对开胸手术患者单肺通气时肺损伤的影响.方法 择期行开胸食管癌根治术患者30例,ASA分级Ⅰ或Ⅱ级,年龄45 ～ 70岁,体重50～ 70kg,采用随机数字表法分为2组（n=15）：对照组（C组）和远隔缺血预处理联合右美托咪定组（ORD组）.ORD组于气管插管完成后10 min,阻断下肢血流5 min,恢复灌注5 min,重复3次,进行缺血预处理,同时先静脉输注负荷量右美托咪定1.0 μg/kg 15 min,然后以0.5μg·kg-1 ·h-1的速率静脉输注至术毕.于单肺通气即刻、30 min、1、和2 h（T1-4）时,采集桡动脉血样,进行血气分析,计算氧合指数和呼吸指数,采用酶联免疫吸附法测定血浆TNF-α、IL-1β和IL-10的浓度.于T1和T34时,收集呼出气冷凝液,测定pH值.结果 与C组比较,ORD组T2-4时氧合指数升高,呼吸指数降低,T3-4时血浆TNF-α和IL-1β的浓度降低,呼出气冷凝液pH值升高,T4时血浆IL-10浓度升高（P＜0.05）.结论 远隔缺血预处理联合右美托咪定可抑制开胸手术患者单肺通气时的炎性反应,减轻气道酸化,从而减轻肺损伤.Objective To investiga~ the effect of remote ischemic preconditioning （RIPC） combined with dexmedetomidine on the lung injury during one-lung ventilation （OLV） in the patients undergoing thoracic surgery.Methods Thirty ASA physical status Ⅰ or Ⅱ patients,aged 45-70 yr,weighing 51-69 kg,scheduled for elective radical operation for esophageal cancer,were randomly divided into 2 groups （n =15 each） using a random number table：control group （group C） and RIPC combined with dexmedetomidine group （group ORD）.In ORD group,at 10 min after endotracheal intubation,RIPC was induced by 3 cycles of 5 min lower extremity ischemia followed by 5 min reperfusion,and at the same time a loading dose of dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min and then dexmedetomidine was infused at a rate of 0.5 μg· kg-1 · h-1 until the end of operation.At 0,30 min,1 h and 2 h of OLV （T1-4）,blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α （TNF-α）,interleukin-1β （IL-1β） and IL-10.Oxygenation index and respiratory index were calculated.Exhaled breath condensate was collected at T1,T3 and T4,and the pH value was measured.Results Compared with group C,oxygenation index was significantly increased,and respiratory index was decreased at T2-4,the plasma concentrations of TNF-α and IL-1β were decreased,and the pH value of exhaled breath condensate was increased at T3-4,and the plasma concentration of IL-10 was increased at T4 in group ORD.Conclusion RIPC combined with dexmedetomidine can inhibit inflammatory responses and reduce airway acidification,thus attenuating the lung injury during OLV in the patients undergoing thoracic surgery.

关 键 词：四肢 缺血预处理 右美托咪啶 呼吸 人工 呼吸窘迫综合征 成人 

分 类 号：R655[医药卫生—外科学]