文章摘要
肺保护性通气策略联合右美托咪定对胸腔镜肺癌根治术患者的肺保护作用
Protective effects of dexmedetomidine combined with lung protective ventilation strategy on the lungs in patients undergoing video-assisted thoracoscopic radical resection of pulmonary carcinoma
  
DOI：10.12089/jca.2019.12.010
中文关键词: 右美托咪定  肺保护性通气策略  单肺通气  炎症反应  术后肺部并发症
英文关键词: Dexmedetomidine  Lung protective ventilation strategy  One lung ventilation  Inflammatory response  Postoperative pulmonary complications
基金项目:江苏省肿瘤医院科研基金面上项目(ZM201710)
作者单位E-mail
高蓉 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
顾连兵 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
许仄平 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
王丽君 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
辜晓岚 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科  
卞清明 210009,南京市,江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科 bqm2518@sina.com 
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中文摘要:
      
目的 观察肺保护性通气策略联合右美托咪定对胸腔镜肺癌根治术患者炎症反应及术后肺部并发症的影响。
方法 选择择期行胸腔镜肺癌根治术的患者40例,男23例,女17例,年龄40～64岁,BMI 20～25 kg/m2,ASA Ⅰ或Ⅱ级,随机分为两组:肺保护性通气策略组(P组)和肺保护性通气策略联合右美托咪定组(DP组)。DP组于麻醉诱导前10 min静脉泵注右美托咪定负荷量0.5 μg/kg(10 min泵注完毕),随后以0.6 μg·kg-1·h-1持续泵注至手术结束；P组以等容量生理盐水持续静脉泵注。双肺通气及单肺通气期间所有患者均采用相同的通气策略：VT 6 ml/kg,FiO2 70％,PEEP 5 cmH2O。分别在麻醉诱导前(T0)、单肺通气前即刻(T1)、单肺通气1 h(T2)、单肺通气2 h(T3)、术后2 h(T4)、术后24 h(T5)检测血清TNF-α、IL-6和MPO含量;记录术后肺部并发症情况。
结果 与P组比较,T2-T5时DP组TNF-α、IL-6、MPO含量明显降低(P<0.05)。P组有2例(10％)肺部并发症。
结论 肺保护性通气策略联合右美托咪定用于胸腔镜肺癌根治术能够进一步减轻术中炎症反应,可能有助于减少术后肺部并发症的发生。
英文摘要:
      
Ojective To observe the effects of dexmedetomidine combined with lung protective ventilation strategy on inflammatory response and postoperative pulmonary complications in patients with pulmonary carcinoma undergoing thoracoscopic radical resection.
Methods Forty patients, 23 males and 17 females, aged 40-64 years, BMI 20-25 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled for thoracoscopic radical resection of pulmonary carcinoma were randomly divided into 2 groups: lung protective ventilation strategy group (group P) and dexmedetomidine combined with lung protective ventilation strategy group (group DP). In group DP, dexmedetomidine was given intravenously at 0.5 μg/kg over 10 min before anesthesia induction, followed by intravenous infusion 0.6 μg·kg-1·h-1. Equal volumes of normal saline was given in group P. All patients received VT 6 ml/kg, FiO2 70％, PEEP 5 cmH2O. Concentrations of serum TNF-α, IL-6 and MPO were measured before induction (T0), before OLV (T1), OLV 1 h (T2), 2 h (T3), postoperative 2 h (T4), 24 h (T5). The incidence of postoperative pulmonary complications was recored on the 7th day after operation.
Results Compared with group P, the level of TNF-α, IL-6, MPO at T2-T5 in group DP were obviously decreased (P < 0.05). The incidence of postoperative pulmonary complications was 10％ in group P.
Conclusion Dexmedetomidine combined with lung protective ventilation strategy can attenuate inflammatory response, with the advantage of decreasing the incidence of postoperative pulmonary complications.
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