右美托咪定对亲体肝移植术婴儿术后肺损伤的影响  

Effect of dexmedetomidine on lung injury in infants undergoing liver transplantation

作　　者：孙英[1] 贾莉莉[1] 朱敏[1] 于洪丽[1] 喻文立[1] SUN Ying;JIA Lili;ZHU Min;YU Hongli;YU Wenli(Department of Anesthesiology,Tianjin First Central Hospital,300192 Tianjin,China)

机构地区：[1]天津市第一中心医院麻醉科,300192

出　　处：《临床麻醉学杂志》2021年第4期367-371,共5页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金面上项目(82072219);天津市卫生健康科技项目(ZC20223);天津市第一中心医院院级春风项目(2019CF31);2019天津医学会麻醉学分会中青年科研培育基金项目(TJMZJJ-2019-07)。

摘　　要：目的观察右美托咪定对亲体肝移植术婴儿术后肺损伤的影响。方法选择2019—2020年行择期亲体肝移植患儿120例,男56例,女64例,年龄4~12个月,ASAⅡ或Ⅲ级。采用随机数字表法将患儿分为两组:右美托咪定组(D组)和对照组(C组),每组60例。D组于麻醉诱导后静脉输注负荷剂量右美托咪定1μg/kg,持续泵注10 min,随后以0.3μg·kg^(-1)·h-1持续静脉泵注至术毕,C组持续输注相同容量生理盐水至术毕。分别于麻醉诱导后(T_(1))、无肝期后30 min(T_(2))、缺血-再灌注后1 h(T_(3))、关腹即刻(T_(4))和术后24 h(T_(5))采集中心静脉血3 ml,采用ELISA法检测血清克拉拉分泌蛋白16(CC16)、表面活性蛋白(SP-D)、高级糖基化终末产物可溶性受体(sRAGE)、IL-6、TNF-α浓度;记录T_(1)—T_(4)时HR、MAP、CVP。记录手术时间、无肝期时间、术中失血量、输血量、输血浆量和尿量。记录术后拔管时间(手术结束至ICU拔除气管插管时间)、ICU停留时间;记录术后1周内急性肺损伤(ALI)、肺部感染、胸腔积液、肺不张、急性呼吸窘迫综合征(ARDS)、呼吸衰竭再插管等发生情况。结果与T_(1)时比较,T_(2)—T_(5)时两组血清CC16、SP-D、sRAGE、IL-6、TNF-α浓度明显升高(P<0.05),T_(2)时C组MAP明显降低,HR明显增快(P<0.05)。与C组比较,T_(2)—T_(5)时D组血清CC16、TNF-α浓度明显降低,T_(2)和T_(3)时D组SP-D、sRAGE、IL-6浓度明显降低(P<0.05),D组术后ALI、肺部感染和ARDS发生率明显降低,术后拔管时间明显缩短(P<0.05)。结论右美托咪定能够抑制肺损伤标记物及炎性因子释放,稳定血流动力学,减轻术后肺损伤。Objective To observe the effect of dexmedetomidine on postoperative lung injury in children undergoing liver transplantation.Methods A total of 120 children undergoing elective related liver transplantation from 2019 to 2020,56 males and 64 females,aged 4-12 months,ASA physical statusⅡorⅢ,were selected.Children were randomly divided into two groups(n=60)using a computer-generated random number table:dexmedetomidine group(group D)and control group(group C).After induction of anesthesia,dexmedetomidine was infused in a loading dose of 1μg/kg for 10 minutes followed by a continuous infusion of 0.3μg·kg^(-1)·h-1 in group D.The equal volume of 0.9%normal saline was given instead in group C until the end of operation.Immediately after anesthesia induction(T_(1)),aT_(3)0 minutes of anhepatic phase(T_(2)),aT_(1)hour of neohepatic phase(T_(3)),immediately after peritoneum closure(T_(4)),and aT_(2)4 hours after operation(T_(5)),blood samples were collected from the central vein to detect the content of clara cell secretory protein(CC16),surfactant proteins D(SP-D),soluble receptor for advanced glycation end-products(sRAGE)and concentrations of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in serum by ELISA.MAP,HR,and CVP at T_(1)-T_(4)were recorded.Operation time,anhepatic time,intraoperative blood loss,urine output,blood transfusion and plasma transfusion were record.Postoperative extubation time and ICU length of stay were recorded.Incidence of postoperative acute lung injury(ALI),lung infection,pleural effusion,atelectasis,acute respiratory distress syndrome(ARDS)and reintubation because of respiratory failure within one week were recorded.Results Compared with T_(1),the level of CC16,SP-D,sRAGE,IL-6 and TNF-αwere increased significantly at T_(2)-T_(5)(P<0.05).Compared with group C,the concentrations of CC16,TNF-αwere significantly decreased at T_(2)-T_(5)and the concentrations of SP-D,sRAGE and IL-6 were significantly decreased at T_(2)and T_(3)in group D(P<0.05).MAP was decreased and HR was increase

关 键 词：右美托咪定 肝移植 婴儿 肺损伤 

分 类 号：R726.1[医药卫生—儿科]