右美托咪定对胸腔镜手术新生儿呼吸力学和炎症因子的影响  

Effects of dexmedetomidine on respiratory mechanics and inflammatory factors in neonates undergoing thoracoscopic surgery

作　　者：李娜[1] 乐林莉[1] 王俊 万珍珍[1] 乐呈进[1] 陈林[1] LI Na;YUE Lin-li;WANG Jun;WAN Zhen-zhen;YUE Cheng-jin;CHEN Lin(Department of Anesthesiology,Maternal and Child Health Hospital of Hubei Province,Wuhan HUBEI 430070,China)

机构地区：[1]湖北省妇幼保健院麻醉科,湖北武汉430070

出　　处：《中国新药与临床杂志》2020年第7期410-413,共4页Chinese Journal of New Drugs and Clinical Remedies

基　　金：湖北省卫计委联合基金项目(WJ2018H0165)。

摘　　要：目的观察右美托咪定对胸腔镜手术新生儿呼吸力学和血清炎症因子的影响。方法将拟行胸腔镜手术的先天性膈疝新生儿30例随机分为对照组和右美托咪定组,每组15例。所有患儿均采用静吸复合诱导,术中吸入七氟烷维持麻醉,右美托咪定组麻醉诱导前静脉泵注右美托咪定负荷量0.5μg·kg^-1,后以0.4μg·kg^-1·h-1维持至手术结束,对照组以同样的方式泵注氯化钠注射液。进胸腔后立即建立人工二氧化碳气胸,关胸前停止人工气胸。记录人工气胸前1 min(T0a),人工气胸30 min(T1)和人工气胸60 min(T2)时肺动态顺应性(Cdyn)、气道峰压(Ppeak)、平均气道压(Pmean)值和心率(HR)、平均动脉压(MAP)水平。检测麻醉诱导前5 min(T0)、T1、T2、术毕(T3)时血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)浓度,观察术后24 h内不良反应的发生情况。结果与T0a时比较,T1和T2时2组Cdyn均降低,Ppeak和Pmean均升高(P <0.05)。与对照组比较,右美托咪定组T1和T2时Cdyn升高,Ppeak和Pmean降低(P <0.05)。与T0时比较,T1、T2和T3时2组TNF-α和IL-8浓度均升高(P <0.05),右美托咪定组血清TNF-α、IL-8浓度低于对照组(P <0.05)。2组术后24 h内低血压、心动过缓等不良反应发生率比较无显著差异(P> 0.05)。结论右美托咪定辅助用于新生儿胸腔镜手术麻醉,可优化呼吸力学指标,降低患儿血清炎症因子水平。AIM To investigate the effects of dexmedetomidine on respiratory mechanics and serum inflammatory factors in neonates undergoing thoracoscopic surgery. METHODS Thirty congenital diaphragmatic hernia neonates undergoing thoracoscopic surgery were randomly divided into control group and dexmedetomidine group(15 patients in each). All patients were induced by combined intravenous and inhalation anesthesia,and sevoflurane was inhaled to maintain anesthesia. In the dexmedetomidine group, dexmedetomidine 0.5 μg·kg^-1 was infused before anesthesia induction, and maintained by 0.4 μg·kg^-1·h-1 until the end of operation. In the control group, sodium chloride injection was infused in the same way. The dynamic lung compliance(Cdyn), peak airway pressure(Ppeak), mean airway pressure(Pmean), heart rate(HR) and mean arterial pressure(MAP) were recorded 1 minute before artificial pneumothorax(T0a), 30 minutes after artificial pneumothorax(T1) and 60 minutes after artificial pneumothorax(T2). The concentrations of tumor necrosis factor-α (TNF-α), interleukin-8(IL-8) in serum were recorded 5 minutes before anesthesia induction(T0), T1, T2 and at the end of operation(T3). The adverse reactions were observed within 24 hours after operation. RESULTS Compared with T0a, Cdyn in T1 and T2 of the two groups were significantly lower, Ppeak, Pmean were significantly higher(P < 0.05). Compared with the control group, Cdyn in T1 and T2 of the dexmedetomidine group was significantly higher, and the Ppeak, Pmean were significantly lower(P < 0.05). Compared with T0, the concentrations of TNF-α and IL-8 in T1, T2 and T3 of the two groups were significantly higher(P < 0.05). Compared with the control group, the concentrations of TNF-α, IL-8 in T1, T2 and T3 in the dexmedetomidine group were significantly lower(P < 0.05). There was no significant difference between the two groups in incidence of adverse reactions such as hypotension and bradycardia within 24 hours after surgery(P > 0.05). CONCLUSION Dexmedetomidine can reduce the levels

关 键 词：右美托咪定 婴儿 新生 胸腔镜 呼吸力学 肿瘤坏死因子-Α 白细胞介素-8 

分 类 号：R971[医药卫生—药品]