不同剂量右美托咪定复合乌司他丁对单侧肺叶切除术患者肺损伤的防护作用  

Protective Effects of Different Doses of Dexmedetomidine Combined with Ulinastatin on Pulmonary Injury in Patients Undergoing Unilateral Lobectomy

作　　者：赵军[1] 车向京 ZhaoJun;Che Xiangjing(Department of Anesthesiology,The Secong Hospital of Qinguangdao,Qinguangdao,Hebei,China 066600;Department of Cardiology,Changli People′s Hospital,Qinhuangdao,Hebei,China 066600)

机构地区：[1]河北省秦皇岛市第二医院麻醉科,河北秦皇岛066600 [2]河北省秦皇岛市昌黎县人民医院心内科,河北秦皇岛066600

出　　处：《中国药业》2018年第24期83-86,共4页China Pharmaceuticals

基　　金：山东省青岛市医药科研指导计划项目[2014-WJZD113]

摘　　要：目的探讨右美托咪定复合乌司他丁对单侧肺叶切除术患者肺损伤的防护作用。方法选择医院2014年5月至2017年5月收治的行单侧肺叶切除术患者89例,随机分为对照组(22例)、D_1组(22例)、D_2组(22例)及D_3组(23例),均给予全身复合麻醉,术中均行单肺通气,给予乌司他丁。D_1组、D_2组及D_3组分别给予负荷量为0. 5,1. 0,2. 0μg/kg的右美托咪定,10 min后静脉泵注剂量分别为0. 5,1. 0,2. 0μg/(kg·h),直至手术结束。测量并比较4组患者术后12,24,48,72 h的第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、用力肺活量(FVC)占预计值百分比(FVC%)及FEV_1/FVC。检测并比较4组患者气管插管后5 min(T0),单肺通气后30 min(T_1)、60 min(T_2)、120 min(T3)及恢复双肺通气30 min(T4)时的血清白细胞介素6(IL-6)、白细胞介素10(IL-10)、超氧化物歧化酶(SOD)及丙二醛(MDA)水平。记录4组不良反应的发生情况。结果 D_1组、D_2组、D_3组患者术后12,24,48,72 h肺功能指标均明显高于对照组,且D_3组术后48 h及72 h明显高于D_1组和D_2组同期(P <0. 05);与T0时比较,对照组、D_1组在T_1至T4时的血清IL-6及MDA水平均明显升高,SOD水平均明显下降,在T_2至T_4时的血清IL-10水平均明显升高(P <0. 05),D_2组及D_3组在T_2至T_4时的血清IL-6,IL-10及MDA水平均明显升高,SOD水平均明显下降(P <0. 05);与对照组比较,D_1组及D_2组在T_2至T_4时,以及D_3组在T_1至T_4时的血清IL-6及MDA水平均明显下降,血清IL-10及SOD水平均明显升高(P <0. 05); D_3组在T_2至T_4时的血清IL-6及MDA水平均明显低于D_1组和D_2组,血清IL-10及SOD水平均明显高于D_1组和D_2组(P <0. 05); 4组均未见严重不良反应发生。结论右美托咪定负荷量为1. 0μg/kg或2. 0μg/kg静脉泵注10 min后,再以1. 0μg/(kg·h)或2. 0μg/(kg·h)的剂量持续静脉泵注至术毕联合乌司他丁,对肺叶切除术患者具有肺保护作用。Objective To investigate the protective effect of dexmedetomidine combined with ulinastatin on pulmonary injury in patients undergoing unilateral lobectomy. Methods Totally 89 patients undergoing unilateral lobectomy admitted to the hospital from May 2014 to May 2017 were selected and randomly divided into the control group( 22 cases),D1 group( 22 cases),D2 group( 22 cases) and D3 group( 23 cases). All patients were given general anesthesia,one-lung ventilation and ulinastatin during operation. D1 group,D2 group and D3 group were given dexmedetomidine with load of 0. 5,1. 0 and 2. 0 μg/( kg·h),respectively. 10 min later,the intravenous infusion dose was 0. 5,1. 0 and 2. 0 μg/( kg· h),respectively,until the end of the operation. The forced expiratory volume in one second( FEV1) as percentage of predicted value( FEV1%),forced vital capacity( FVC) percentage of predicted value( FVC%) and FEV1/FVC were measured and compared among the four groups at 12,24,48 and 72 h after operation. The levels of serum interleukin-6( IL-6),interleukin-10( IL-10),superoxide dismutase( SOD) and malondialdehyde( MDA) were measured and compared in the four groups at 5 min after endotracheal intubation( T0),30 min after one-lung ventilation( T1),60 min after one-lung ventilation( T2),120 min after one-lung ventilation( T3) and 30 min after resumption of two-lung ventilation( T4). The incidence of adverse reaction in the four groups was recorded. Results The pulmonary function indexes of D1 group,D2 group and D3 group at 12,24,48 and 72 h after operation were significantly higher than those of the control group,and the pulmonary function indexes of D3 group at 48 and 72 h after operation were significantly higher than those of D1 group and D2 group at the same time points( P < 0. 05). Compared with T0,the levels of serum IL-6 and MDA in the control group and D1 group were significantly increased from T1 to T4,and the levels of SOD in the two groupswere significantly decreased,the levels of serum IL-10 in the two groups were significant

关 键 词：肺叶切除术 单肺通气 右美托咪定 剂量 乌司他丁 肺损伤 临床疗效 

分 类 号：R969.4[医药卫生—药理学] R971.2[医药卫生—药学]