右美托咪定在胸腔镜肺癌根治术中的应用价值  

The application value of dexmedetomidine in thoracoscopic radical surgery for lung cancer

作　　者：汪辉 陈刚[2] 王萍[1] 赵仕浩[1] 吴刚 汪方清[2] WANG Hui;CHEN Gang;WANG Ping(Department of Anesthesiology,Tongling People's Hospital,Tongling 244000,China;Department of Thoracic Surgery,Tongling People's Hospital)

机构地区：[1]铜陵市人民医院麻醉科,安徽铜陵244000 [2]铜陵市人民医院胸外科

出　　处：《腹腔镜外科杂志》2024年第5期326-331,共6页Journal of Laparoscopic Surgery

基　　金：安徽省科技厅重点研发项目(202104j07020003)。

摘　　要：目的:探讨胸腔镜肺癌根治术中应用右美托咪定的临床价值。方法:选择2020年1月至2022年9月收治的80例行胸腔镜肺癌根治术的患者,根据随机数字表法分为两组,每组40例,研究组采取肺保护性通气策略+右美托咪定,对照组采取肺保护性通气策略,比较两组手术时间、输液量、单肺通气时间、出血量、心率、平均动脉压、白介素-6、转化生长因子-β1、肿瘤坏死因子-α、T淋巴细胞亚群、肺功能、氧化应激指标、肺部并发症情况。结果:两组手术时间、输液量、单肺通气时间、出血量差异无统计学意义(P>0.05)。双肺通气时、手术结束时,两组心率、平均动脉压差异无统计学意义(P>0.05);单肺通气30 min、90 min时,研究组心率、平均动脉压均低于对照组(P<0.05)。术前双肺通气时,两组炎性因子差异无统计学意义(P>0.05);单肺通气30 min、90 min及手术结束时,研究组白介素-6、转化生长因子-β1、肿瘤坏死因子-α均低于对照组(P<0.05)。研究组肺部并发症发生率低于对照组(7.50%vs. 27.50%,P<0.05)。术前两组T淋巴细胞亚群、肺功能、氧化应激指标差异无统计学意义(P>0.05),术后研究组除丙二醛低于对照组外,其余各指标均高于对照组(P<0.05)。结论:胸腔镜肺癌根治术中应用肺保护性通气策略+右美托咪定的效果更为理想,可避免血流动力学指标大幅波动,缓解炎性反应,促进肺功能改善,同时减轻氧化应激反应,肺部并发症少,安全性高。Objective:To study the application value of dexmedetomidine in thoracoscopic radical resection of lung cancer.Methods:From Jan.2020 to Sep.2022,80 lung cancer patients who underwent thoracoscopic radical resection were selected.According to random number table,patients were assigned to study group(n=40)and control group(n=40).The study group was treated with the lung protective ventilation strategy and dexmedetomidine;the control group was treated with the lung protective ventilation strategy.Group comparison was performed in the operation time,infusion volume,single lung ventilation time,blood loss,heart rate,mean arterial pressure(MAP),interleukin-6,transforming growth factor-β1,tumor necrosis factor-α,T lymphocyte subsets,pulmonary function,oxidative stress indicators,and pulmonary complications.Results:There were no significant differences between the two groups in operation time,infusion volume,one lung ventilation duration and bleeding volume(P>0.05).At the two-side lung ventilation and the completion of surgery,heart rate and MAP between the two groups were not significantly different(P>0.05);at 30 min and 90 min of one lung ventilation,heart rate and MAP in the study group were lower than those in the control group(P<0.05).Before surgery and during the two-side lung ventilation,the inflammatory factors between two groups were not significantly different(P>0.05);at 30 min and 90 min of one lung ventilation and the completion of surgery,interleukin-6,transforming growth factor-β1 and tumor necrosis factor-αin the study group were lower than those in the control group(P<0.05);the incidence of pulmonary complications in the study group was lower than that in the control group(7.50%vs.27.50%,P<0.05).Before surgery,there were no significant differences in T lymphocyte subsets,lung function,and oxidative stress indicators between the two groups(P>0.05);after surgery,malondialdehyde in the study group was lower than the control group;the other indicators were higher than the control group(P<0.05).Conclusions:

关 键 词：肺肿瘤 肺癌根治术 胸腔镜检查 右美托咪定 肺保护性通气策略 

分 类 号：R614.42[医药卫生—麻醉学]