右美托咪定联合参附注射液对单肺通气患者的肺保护作用  

Pulmonary protection of dexmedetomidine combined with Shenfu injection in patients undergoing one lung ventilation

作　　者：丁艺[1] 李永录[1] 林雅丽[1] 蔡元春[1] 银世杰[1] 石俊丹 莫科林[1] 

机构地区：[1]广西中医药大学第一附属医院,广西南宁530023

出　　处：《现代中西医结合杂志》2016年第13期1372-1374,1441,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：广西壮族自治区卫生及计划生育委员会课题(Z2015463)

摘　　要：目的探讨右美托咪定联合参附注射液对肺癌根治术患者单肺通气时的肺保护作用及相关机制。方法选取择期行肺癌根治术患者48例,ASA分级Ⅰ~Ⅱ级。随机分为右美托咪定组（右美组）、右美托咪定联合参附注射液组（联合组）及对照组各16例。在麻醉诱导前30 min,右美组和联合组静脉输注右美托咪定10 min,负荷量1.0μg/kg;联合组同时静脉输注参附注射液（1.5 m L/kg加入生理盐水至250 m L）,20 min内输完;对照组给予等容量生理盐水。分别在麻醉诱导后即刻（t1）、单肺通气60 min（t2）、恢复双肺通气30 min（t3）及术后2 h（t4）采集外周静脉血,测定血清TNF-α、IL-6、IL-8水平及超氧化物歧化酶（SOD）活性和丙二醛（MDA）含量。结果 t2~t4时,3组TNF-α、IL-6及IL-8水平均明显高于t1时（P均〈0.05）。t2~t4时,右美组和联合组IL-6及IL-8水平均明显低于对照组（P均〈0.05）;t3~t4时,TNF-α水平均明显低于对照组（P均〈0.05）;t2~t4时,联合组TNF-α、IL-6及IL-8水平均明显低于右美组（P均〈0.05）。t3~t4时,右美组和联合组SOD活性明显高于对照组,MDA含量明显低于对照组,且联合组SOD活性明显高于右美组,MDA含量明显低于右美组,差异均有统计学意义（P均〈0.05）。结论右美托咪定联合参附注射液可以明显降低单肺通气时及术后炎性细胞因子水平,减轻肺组织的炎性反应,同时具有较强的抗氧化应激损伤能力,二者联用肺保护作用强于单用右美托咪定。Objective It is to evaluate the pulmonary protection of dexmedetomidine combined with Shenfu injection in patients undergoing one lung ventilation for lung cancer operation,and clarify the protective mechanism. Methods 48 cases ASAⅠ- Ⅱ patients scheduled for elective radical operation for lung cancer were randomized into three groups（ n = 16 each group） ： dexmedetomidine group（ group D）,dexmedetomidine combined with Shenfu injection group（ group DS） and control group（ group C）. Before induction of anesthesia,the group D and group DS were infused dexmedetomidine for 10 min（ loading dose was 1. 0 μg / kg）,while Shenfu injection was infused in group DS for 20 min（ 1. 5 m L / kg ＋ 250 m L normal saline）.Equal volume saline was infused at the same time in group C. Venous blood sample were taken after induction of anesthesia（ t1）,at 60 min of OLV（ t2）,30 min after re- expansion of the collapsed lung（ t3） and 2 hours after operation（ t4）. The serum concentrations of TNF- α,IL- 6 and IL- 8 were detected by ELISA,while the serum SOD activity and MDA concentration were measured. Results Compared with group C,the levels of IL- 6 and IL- 8 were significantly decreased at t2- t4,while the level of TNF- α was also decreased at t3- t4 in group D and group DS（ P〈0. 05）. The concentrations of TNF- α,IL- 6 and IL- 8 were obviously decreased at t2- t4 in group DS（ P〈0. 05）. Compared with group C,the SOD activity were significantly increased at t3- t4,while the level of MDA were dramatically decreased in group D and group DS（ P〈0. 05）. In group DS,the SOD activity was more higher,and the level of MDA was lower than group D（ P〈0. 05）. Conclusion Dexmedetomidine combined with Shenfu injection could markedly reduce the levels of inflammatory cytokines and inflammatory reaction in lung,which can alleviate the oxidative injury. Dexmedetomidine combined with Shenfu injection has greater protective effect on the lung in patients undergoing OLV compared with dexmede

关 键 词：右美托咪定 参附注射液 单肺通气 肺癌根治术 氧化应激 

分 类 号：R971.2[医药卫生—药品]