右美托咪定对成骨不全患者高氧肺损伤的保护作用  

Protective Effects of Dexmedetomidine on Lung Injury linduced by High Concentration Oxygen During General Anesthesia of Osteogenesis Imperfect Patient

作　　者：黄美娜[1] 刘继强[1] 庞悦 李月玲 HUANG Mei-na;LIU Ji-qiang;PANG Yue(Department of anesthesiology,Wuqing district peoples hospital,Tianjin 301700)

机构地区：[1]天津市武清区人民医院麻醉科,天津301700

出　　处：《中国伤残医学》2021年第15期7-10,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:评价右美托咪定对脆骨病患者全麻高氧肺损伤的保护作用。方法:择期存在脊柱侧弯和/或胸廓畸形的成骨不全患者40例,麻醉时间超过4小时者,年龄18-40岁,ASA Ⅰ-Ⅱ级。采用随机数字表法,将其分为2组(n=20):右美托咪定组(D组)和对照组(C组)。D组于麻醉诱导前10分钟经静脉输注右美托咪定负荷量1.0ug/kg,随后以0.6ug·kg^(-1)·h^(-1)速率静脉输注至手术结束前10分钟。C组给予等容量生理盐水。所有患者麻醉插管后,均吸入纯氧,分别于机械通气后即刻(T_(0))、1小时(T_(1))、2小时(T_(2))3小时(T_(3))、4小时(T_(4))抽取动脉血3ml。其中1ml动脉血进行血气分析,并计算氧和指数(OI);其余2ml用于检测每组患者血清丙二醛(MDA)浓度及超氧化物歧化酶(SOD)活力及肿瘤坏死因子-α(TNF-α)浓度。结果:2组患者OI、TNF-α、MDA及SOD在T_(0)时间点差异无统计学意义(P>0.05)。与T_(0)相比,2组患者OI及SOD活力随时间延长逐渐降低,MDA及TNF-α浓度逐渐升高;与C组相比,D组患者在T_(3)、T_(4)时间点血清MDA及TNF-α浓度均明显下降,而SOD活力和OI在T_(4)时间点显著增加(P<0.05)。结论:右美托咪定可抑制成骨不全患者高浓度氧造成的氧化应激反应,从而在临床实践中发挥肺保护作用。Objective:To evaluate the pulmonary protection by dexmedetomidine on lung injury induced by high concentration oxygen during general anesthesia of Osteogenesis imperfect patient.Methods:Forty cases of Osteogenesis imperfect patient with scoliosis and/or thoracic deformity aged 18-30yr,of ASA physical status Ⅰ-Ⅱ who undergoing more than 4 hours anesthesia,were randomized into 2 groups(n=20 each):dexmedetomidine group(group D)and control group(group C).Before induction of anesthesia,a loading dose of dexmedetomidine 1.0ug/kg was infused over 10 min,followed by continuous infusion of dexmedetomidine at a rate of 0.6ug·kg^(-1)·h^(-1) until skin suture in group D,while the equal volume of normal saline was given in group C.Immediately after induction of anesthesia,every patient was given ventilation with high concentration oxygen,inhalation of oxygen concentration is above 95%.Immediately after ventilation(T_(0)),at 1 hour(T_(1))、2 hours(T_(2))3 hours(T_(3))and 4 hours(T_(4))of ventilation,3ml arterial blood samples were collected,1ml for blood gas analysis by what Oxygenation index was calculated,and 2ml for determination of the serum concentrations of MDA、SOD and TNF-α.Results:The difference of the levels of OI、TNF-α、SOD and MDA between the two groups has no statistically significant at T_(0)(P>0.05).Compared with T_(0),the activity of OI and SOD in the two groups decreased gradually with time,and the concentration of MDA and TNF-α increased gradually;compared with group C,the concentration of MDA and TNF-α in the serum of group D decreased significantly at the time of T_(3) and T_(4),while the activity of SOD and OI increased significantly at the time of T_(4)(P<0.05).Conclusion:Dexmedetomidine can protect the lung from the high concentration oxygen injury,and the inhibition of oxidative stress reaction may be involved in the mechanism.

关 键 词：右美托咪定 成骨不全 氧化应激反应 肺损伤 肺保护 

分 类 号：R614[医药卫生—麻醉学]