右美托咪定联合盐酸艾司洛尔对肺癌根治术病人肺保护作用及其对Toll样受体4/核因子-κB信号通路的影响  

Effects of dexmedetomidine combined with esmolol on lung protection and its effect on TLR4/NF-κB signaling pathway in patients with radical lung cancer

作　　者：武长君 钱鹏[1] WU Changjun;QIAN Peng(Department of Anesthesiology,Panzhihua Second People's Hospital,Panzhihua,Sichuan 617068,China)

机构地区：[1]攀枝花市第二人民医院麻醉科,四川攀枝花617068

出　　处：《安徽医药》2021年第6期1246-1250,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨右美托咪定联合盐酸艾司洛尔对肺癌根治术病人肺保护作用及其对Toll样受体4/核因子-κB(TLR4/NF-κB)信号通路的影响。方法回顾性选取2017年10月至2018年12月攀枝花市第二人民医院择期行肺癌根治术的肺癌病人80例为研究对象,根据治疗方法的不同将病人分为对照组与联合组,每组各40例。对照组:应用右美托咪定;联合组:在对照组的基础上应用盐酸艾司洛尔。分别于术前(T1)、开胸后(T2)、单肺通气60 min(T3)、手术结束时(T4),采用酶联免疫吸附测定(ELISA)检测血清炎性因子白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子α(TNF-α)的水平;采用ELISA检测肺组织匀浆上清液中丙二醛、髓过氧化物(MPO)、黄嘌呤氧化酶(XOD)的水平;检测动脉血氧分压(PaO2)、氧合指数、气道平台压(APP)、气道阻力、中性粒细胞(PMN)数量;实时荧光定量逆转录聚合酶链反应(qRT-PCR)检测TLR4、NF-κB mRNA的表达水平。结果用药和时间的交互作用对IL-6、IL-8、TNF-α、丙二醛、MPO、XOD、PaO2、氧合指数、APP、气道阻力、PMN数量的影响差异有统计学意义(P<0.05),联合组在T2、T3、T4时间点IL-6[(16.52±2.32)/(30.20±6.21)/(33.21±5.31)ng/L比(29.63±8.52)/(42.36±10.19)/(55.41±6.85)ng/L]、IL-8[(9.62±1.03)/(11.52±2.11)/(18.24±1.54)ng/L比(13.52±1.41)/(18.67±3.21)/(30.21±3.52)ng/L]、TNF-α[(10.21±1.21)/(20.31±1.42)/(30.19±2.46)ng/L比(15.42±3.32)/(39.47±6.21)/(45.41±6.16)ng/L]、丙二醛[(5.63±0.22)/(5.72±0.21)/(6.32±0.33)mmol/L比(10.32±1.03)/(12.31±1.01)/(15.62±1.12)mmol/L]、MPO[(6.35±1.02)/(7.31±1.12)/(6.30±1.08)μg/L比(8.35±1.13)/(11.21±1.30)/(12.13±0.56)μg/L]、XOD[(5.61±0.85)/(5.14±0.26)/(4.21±0.13)μg/L比(7.61±1.10)/(8.64±1.32)/(10.51±2.21)μg/L]、APP[(18.62±2.13)/(16.62±1.32)/(13.25±1.13)cmH2O比(22.31±3.24)/(22.96±2.18)/(15.32±1.02)cmH2O]、气道阻力[(15.62±1.10)/(14.33±1.12)/(13.20±1.01)cmH2O/LS比(17.92±1.16)/(16.34±1Objective To investigate the protective effect of dexmedetomidine combined with esmolol on lung cancer patients and its effects on Toll-like receptor 41 nuclear factor-κB(TLR4/NF-κB)signaling pathway.Methods Eighty patients with lung cancer who underwent radical surgery of lung cancer in Panzhihua Second People’s Hospital from October 2017 to December 2018 were retrospectively selected as the research subjects,and the patients were assigned into the control group and the combination group according to different treatment methods,with 40 patients in each group.Patients in the control group were treated with dexmedetomidine,and patients in the combination group were treated with esmolol hydrochloride on the basis of the treatment adopted in the control group.ELISA method was used to detect the levels of interleukin-6(IL-6),interleukin-8(IL-8)and tumor necrosis factor-α(TNF-α)at pre-operation(T1),after thoracotomy(T2),one-lung ventilation for 60 minutes(T3),and at the end of operation(T4),respectively.ELISA method was used to detect the levels of malondialdehyde(MDA),myeloperoxidase(MPO)and xanthine oxidase(XOD).arterial partial pressure of oxygen(PaO2),oxygenation index(OI),airway plateau pressure(APP),airway resistance,and the number of polymorphonuclear leukocytes(PMN)were detected.Real-time fluorescence quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to detect the expressions of TLR4 and NF-κB mRNA.Results The interaction of medication and time had statistically different effects on IL-6,IL-8,TNF-α,MDA,MPO,XOD,PaO2,APP,AR,and the number of PMN(P<0.05).In the combination group,there were significantly lower levels of IL-6[(16.52±2.32)/(30.20±6.21)/(33.21±5.31)ng/L vs.(29.63±8.52)/(42.36±10.19)/(55.41±6.85)pg],IL-8[(9.62±1.03)/(11.52±2.11)/(18.24±1.54)ng/L vs.(13.52±1.41)/(18.67±3.21)/(30.21±3.52)ng/L],TNF-α[(10.21±1.21)/(20.31±1.42)/(30.19±2.46)ng/L]vs.[(15.42±3.32)/(39.47±6.21)/(45.41±6.16)ng/L],MDA[(5.63±0.22)/(5.72±0.21)/(6.32±0.33)mmol/L vs.(10.32±1

关 键 词：肺肿瘤 肺切除术 麻醉 静脉 右美托咪定 艾司洛尔 肺功能 炎症 氧化应激 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]