右美托咪定对肺癌患者手术期间肺内分流及炎性反应的影响  

Effects of dexmedetomidine on perioperative pulmonary shunt fraction and inflammatory reactions in patients with pulmonary cancer

作　　者：曹刚[1] 朱浩[1] 黄自生[1] 

机构地区：[1]宁波市第一医院,浙江宁波315010

出　　处：《中国医院药学杂志》2015年第9期822-824,共3页Chinese Journal of Hospital Pharmacy

基　　金：浙江省医学会临床科研基金项目(编号:20114ZYC-A05)

摘　　要：目的:研究右美托咪定对肺癌根治术患者手术期间肺内分流及炎性反应的影响。方法:60例择期行右上叶肺癌根治术患者,ASA I^II级,随机分为2组(n=30):右美托咪定组(D),于气管插管前10 min泵注负荷量1μg·kg-1,并按0.5μg·kg-1·h-1持续泵注至关胸;空白组(C组),给予等容量生理盐水作对照。分别于麻醉双肺通气后15 min(T0)、单肺通气15min(T1)、单肺通气1 h(T2)、恢复双肺通气15 min(T3)经颈内静脉、桡动脉采血做血气分析,计算肺内分流(Qs/Qt)以及酶联免疫法检测IL-6、IL-10浓度。结果:与T0时比较,T1、T2时2组肺内分流及IL-6、IL-10有统计学差异(P<0.05);与C组比较,D组T1、T2时肺内分流减少及IL-6、IL-10的浓度降低(P<0.05)。结论:右美托咪定对肺内分流有一定的改善作用,且能抑制手术过程中的炎症反应,对围术期进行肺保护起到积极作用。OBJECTIVE To investigate effects of dexmedetomidine（Dex）on perioperative pulmonary shunt fraction and inflammatory reactions in patients with pulmonary cancer.METHODS Sixty ASA Ⅰ-Ⅱ patients（two groups,30 patients in each）scheduled for lobectomy under general anesthesia were randomly assigned into two groups to intravenously receive dexmedetomidine（D）or saline（C group）.Patients in group Dex received intravenously a loading dose of 1.0microg·kg^-1 before general anesthesia over 10 min,followed by continuous infusion of dexmedetomidine at rate of 0.5 microg·kg^-1·h^-1.Normal saline of equal volume was administrated in patients in group C.Blood samples were obtained at four time points：two lung ventilation 15 min（T0）,one-lung ventilation 15 min（T1）,one-lung ventilation 1 h（T2）,to restore two lung ventilation 15min（T3）via internal jugular vein and radial artery to perform blood gas analysis.Intrapulmonary shunt（Qs/Qt）,IL-6 and IL-10 were calculated and detected.RESULTS Compared to T0,the pulmonary shunt fraction was reduced,the plasma concentrations of IL-6 and IL-10 were increased in both groups at the T1 and T2.Compared to group C,the pulmonary shunt fraction and the plasma concentration of factors（IL-6,IL-10）were statistically significant（P〈0.05）at the time points T1,T2 and T1,T2,T3.CONCLUSION Dexmedetomidine can reduce pulmonary shunt fraction and inflammatory reactions during one lung ventilation in patients undergoing elective lobectomy.It has positive effects on lung protection in clinical practice.

关 键 词：右美托咪定 单肺通气 肺内分流 白介素6(IL-6) 白介素10(IL-10) 肺损伤 

分 类 号：R971[医药卫生—药品]