右美托咪啶对行膝关节置换术的患者肺保护作用的研究  

Study on lung protective effect of Dexmedetomidine in knee joint replacement surgery

作　　者：黄培龙 刘琳琳 陈宇[3] 许笑彬 吕浩[3] 

机构地区：[1]北京朝阳中西医结合急诊抢救中心麻醉科,100022 [2]河南省许昌市妇幼保健院麻醉科,461000 [3]海军总医院麻醉科,100048

出　　处：《中国疗养医学》2017年第5期515-517,共3页Chinese Journal of Convalescent Medicine

摘　　要：目的探讨右美托咪定对膝关节置换术患者的肺保护作用及相关机制。方法选择择期行单膝关节置换术患者40例,随机分为两组:右美托咪定组(D组)和对照组(C组),每组各20例。D组麻醉诱导后采用右美托咪定0.7μg/(kg·min)维持麻醉,C组泵入等量的生理盐水,两组均采用同样药物进行静吸复合麻醉。分别于麻醉诱导后5 min(T_0)、手术开始时(T_1)、骨水泥置入后5 min(T_2)、手术结束即刻(T_3)、手术拔管后15 min(T_4)五个时间点采集两组患者动脉血及外周静脉血,进行动脉血气分析及测定静脉血清TNF-α、IL-6、IL-8、IL-10水平;记录各时间点患者的潮气量(V_T)、气道压的最大值(P_(max))和最小值(P_(min)),计算肺泡氧合指数(O I)和肺顺应性(CL)。结果 T2~T4时刻,D组TNF-α、IL-6和IL-8水平均明显低于C组(P<0.05),而IL-10明显高于C组(P<0.05);两组患者肺泡氧合指数(O I)T2~T4时刻较T0时增高(P<0.05),D组明显高于C组(P<0.05)。T2~T4时两组肺顺应性(CL)低于T0时点,且D组明显高于C组(P<0.05)。结论右美托咪啶能抑制炎症因子TN F-α、IL-6、IL-8的表达,并能促进抗炎因子IL-10的释放,提高患者的肺顺应性,减轻膝关节置换手术给患者造成的肺损伤,具有肺保护作用。Objective To investigate the lung protective effect of Dexmedetomidine in sufferers with knee joint replacement surgery.Methods 40 sufferers undergoing time-elective single knee joint replacement surgery were studied and randomly divided into two groups ： Dexmedetomidine group（Group D） and control group（Group C）, with 20 cases in each group.After anesthesia induction,Group D were given Dexmedetomidine （0.7 μg/kg ·m in） for anesthesia maintenance ,while Group C were given equal normal saline.Both groups had intravenous inhalational anesthesia.The arterial blood and peripheral venous blood of the sufferers in both groups were collected at the five following time points ： 5 minutes instantly after anesthesia induction（T0）, operation beginning time（Tl）, 5 min after bone cement placement （T2） and time instantly after operation （T3） and 15 min after extubation（T4）, then the arterial blood gas analysis was performed, and TNF- α , IL-6, IL-8, and IL-10 of venous serum were measured.VT, Pmin and Pmin of all sufferers at each time point were recorded, then the oxygenation index （OI） of pulmonary alveoli and compliance of lung （CL） were calculated.Results At T2 to T4,Group D had lower TNF-α ,IL-6 and IL-8 levels（P〈0.05） and higher IL-10 （P〈0.05） than Group C.Compared to To, OI in both groups got higher at T2-T4 （P〈0.05）,and OI of Group D was higher than Group C（P〈0.05）.CL in both groups got lower at T2-T4 than at To, and CL of Group D was higher than Group C（P〈0.05）.Gonclusion Dexmedetomidine can restrain the expression of inflammatory factors of TNF-α, IL-6 and IL-8, promote the expression of anti-inflammatory factor of IL-10, and improve lung compliance of the sufferers.Dexmedetomidine can relieve lung injuries in sufferers with knee joint replacement surgery, bearing lung protective effect.

关 键 词：右美托咪啶 膝关节置换术 肺栓塞 肺保护 

分 类 号：R614[医药卫生—麻醉学]