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| 右美托咪定对选择性肺叶隔离下食管癌手术患者血清细胞因子和肺功能的影响 |
| Effects of dexmedetomidine combined with selective lobectomy on lung function and serum cytokines in patients undergoing esophageal cancer surgery |
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| DOI：10.12089/jca.2018.11.012 |
| 中文关键词: 食管癌 选择性肺叶隔离技术 右美托咪定 细胞因子 肺功能 |
| 英文关键词: Esophageal cancer Selective lung lobe isolation technique Dexmedetomidine Cytokines Pulmonary function |
| 基金项目:盐城市医学科技发展计划项目（YK 2013093） |
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| 中文摘要: |
目的 观察右美托咪定对选择性肺叶隔离下食管癌手术患者血清细胞因子和肺功能的影响。
方法 选择45例食管癌患者,男25例,女20例,年龄40～70岁, BMI 18～30 kg/m2,ASA Ⅰ或Ⅱ级。按随机数字表分为左全肺隔离单肺通气组(O组)、选择性左下肺叶隔离组(S组)、选择性左下肺叶隔离联合右美托咪定组(SD组),每组15例。所有患者均采用支气管堵塞器法肺叶隔离。O组行左全肺隔离,术中右肺单肺通气;S组和SD组行左下肺叶隔离,术中右肺单肺通气+左上肺通气。SD组自麻醉诱导时静注右美托咪定负荷剂量1 μg/kg(10 min),以0.3 μg·kg-1·h-1维持至手术结束前30 min。S组和O组静注等容量生理盐水。记录气管插管后即刻(T1)、单肺通气或选择性肺叶隔离通气30 min(T2)、60 min(T3)、术毕(T4)时血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)浓度,记录麻醉诱导后5 min(T1a)、单肺通气或选择性肺叶隔离通气后15 min(T2a)、45 min(T3a)、恢复双肺通气后15 min(T4a)时的气道平台压(Pplat)、气道峰压(Ppeak)、动态肺顺应性(Cdyn),记录手术时间、住院时间和术后肺部并发症发生情况。
结果 与T1时比较, T2—T4时三组TNF-α、IL-8、IL-10浓度明显升高(P<0.05);T2—T4时SD组TNF-α、IL-8、IL-10浓度明显低于O组和S组,S组明显低于O组(P<0.05);与T1a时比较，T2a、T3a时三组Pplat、Ppeak明显升高,Cdyn 明显降低(P<0.05);与O组比较,T2a、T3a时S组、SD组Pplat和Ppeak明显降低,Cdyn明显升高(P<0.05)。SD组住院时间明显短于、术后肺部并发症发生率明显低于O组、S组(P<0.05)。
结论 右美托咪定联合选择性肺叶隔离技术,可优化食管癌手术患者的呼吸力学指标,减少机体细胞因子的释放,降低患者术后肺部并发症发生率。 |
| 英文摘要: |
Objective To observe the effects of dexmedetomidine on serum cytokines and pulmonary function in patients with esophageal cancer under selective pulmonary sequestration.
Methods Forty-five patients with esophageal cancer were selected for prospective study, 25 males and 20 females, aged 40 - 70 years, BMI 18-30 kg/m2, falling into ASA physical status Ⅰ-Ⅱ. They were divided into group O (left whole lung isolation single lung ventilation), group S (selective left lower lobe isolation), group SD (selective left lower lobe isolation combined with dexmedetomidine) according to the random number table, 15 cases in each group. All the patients in the three groups were isolated by bronchooccluder. Group O underwent left whole lung isolation, intraoperative right lung single lung ventilation; left lower lobe isolation was performed in groups S and SD, intraoperative right lung single lung ventilation+left upper lung ventilation. In group SD, the dosage of dexmedetomidine was administered by 1 μg/kg (10 min) when induced by anesthesia, and was maintained at 0.3 μg·kg-1·h-1 until half an hour before the end of the operation. In groups S and O, the same volume of normal saline was intravenously injected. Monitoring intraoperative hemodynamics, serum TNF-α, IL-8 and IL-10 concentrations were detected immediately after tracheal intubation (T1), single lung ventilation or selective isolated lung ventilation for 30 min (T2), 60 min (T3), and end of the surgery (T4). Airway plateau pressure (Pplat), peak airway pressure (Ppeak), dynamic lung compliance (Cdyn) and operative time, length of stay, and postoperative pulmonary complication rate at the moment of 5 min after induction of anesthesia (T1a), 15 min (T2a), 45 min (T3a), after single lung ventilation or selective lobectomy, 15 min after recovery of bilateral lung ventilation (T4a) were recorded.
Results Compared with T1 time point, the concentrations of TNF-α, IL-8 and IL-10 in three groups at T2-T4 time point were significantly increased (P < 0.05). In group SD, the concentrations of TNF-α, IL-8 and IL-10 at T2-T4 time point were lower than those in groups O and S, and those in the group S were lower than those in the group O (P < 0.05). Pplat and Ppeak at the time points of T2a and T3a were significantly increased and Cdyn significantly decreased (P < 0.05). Compared with group O, Pplat and Ppeak were significantly decreased in groups S and SD at T2a and T3a, and cdyn significantly increased (P < 0.05). The hospitalization time and incidence of postoperative pulmonary complications in group SD were significantly lower than those in groups O and S (P < 0.05).
Conclusion Dexmedetomidine combined with selective lung lobe isolation technique can optimize the respiratory mechanical index of patients with esophageal cancer surgery, reduce the release of cytokines and reduce the incidence of postoperative pulmonary complications. |
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