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| 右美托咪定对肺癌根治术患者单肺通气相关肺损伤的影响 |
| Effect of dexmedetomidine on one-lung ventilation-related lung injury in patients undergoing radical operation for lung cancer |
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| DOI：10.12089/jca.2021.11.001 |
| 中文关键词: 右美托咪定 炎症介质 水通道蛋白 单肺通气 急性肺损伤 |
| 英文关键词: Dexmedetomidine Flammatory mediators Aquaporin One lung ventilation Acute lung injury |
| 基金项目:广西壮族自治区卫生厅科研课题（Z2016264） |
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| 中文摘要: |
目的 评价右美托咪定对肺癌根治术患者单肺通气（OLV）相关肺损伤的影响。
方法 选择择期行肺癌根治手术的患者40例，男30例，女10例，年龄42～70岁，ASA Ⅰ或Ⅱ级，且术中OLV超过2 h。采用随机数字表法将患者分为两组：右美托咪定组（D组）和对照组（C组），每组20例。麻醉诱导后，D组给予右美托咪定初始剂量0.5 μg/kg，给药时间大于10 min，继之以0.5 μg·kg-1·h-1的速度维持至手术结束前30 min，C组给予等容量的生理盐水。分别于给药前即刻、OLV 60、90和120 min、恢复双肺通气30 min时采集桡动脉血，测定血清肿瘤坏死因子-α（TNF-α）、白细胞介素-8 （IL-8）浓度，并进行血气分析，计算氧合指数（OI）和动态肺顺应性（Cdyn）；免疫组织化学法观察OLV前即刻、肺叶离体时肺组织肺水通道蛋白5（AQP5）的染色程度，计算免疫组织化学评分。
结果 与给药前即刻比较，OLV 60、90和120 min、恢复双肺通气30 min时两组血清TNF-α、IL-8浓度明显升高（P<0.05），OI和Cdyn明显降低（P<0.05）。OLV 60、90和120 min、恢复双肺通气30 min时D组血清TNF-α、IL-8浓度明显低于C组（P<0.05），OI明显高于C组（P<0.05）。OLV 90、120 min时D组Cdyn明显高于C组（P<0.05）。肺叶离体时D组AQP5蛋白染色程度明显深于C组，AQP5蛋白免疫组织化学评分明显高于C组（P<0.05）。
结论 右美托咪定降低血清TNF-α、IL-8 浓度，促使AQP5 在肺组织中表达的增强，减轻肺癌根治术患者单肺通气期间的肺损伤，改善肺功能。 |
| 英文摘要: |
Objective To evaluate the effect of dexmedetomidine on one-lung ventilation-related lung injury in patients undergoing radical operation for lung cancer.
Methods Forty patients, 30 males and 10 females, aged 42-70 years, ASA physical status Ⅰ or Ⅱ, scheduled for lung cancer radical operation with intraoperative one-lung ventilation (OLV) exceeding 2 hours, were divided into two groups using random number table method: dexmedetomidine group (group D) and control group (group C), 20 cases in each group. In group D, dexmedetomidine 0.5 μg/kg (initial dose) was given for more than 10 minutes after anesthesia induction, followed by continuous infusion at 0.5 μg·kg-1·h-1 until 30 minutes before the end of operation. The equal volume of normal saline was given instead of dexmedetomidine in group C. Before administration, and at 60 minutes, 90 minutes and 120 minutes of OLV, and 30 minutes after recovery of bilateral lung ventilation, arterial blood samples were collected for determination of serum tumor necrosis factor alpha (TNF-α) and interleukin 8 (IL-8) concentrations and for blood gas analysis. Oxygenation index (OI) and dynamic lung compliance (Cdyn) were calculated. The staining degree of aquaporin-5 (AQP5) in lung tissues before OLV and at the time of lobectomy of lungs were observed using immunohistochemistry method. The immunohistochemical score was calculated.
Results Compared with the value before administration, the serum concentrations of TNF-α and IL-8 were significantly increased (P < 0.05), and OI and Cdyn decreased significantly in both groups 60 minutes, 90 minutes and 120 minutes of OLV, and 30 minutes after recovery of bilateral lung ventilation (P < 0.05). Compared with group C, the serum concentrations of TNF-α and IL-8 were significantly decreased and OI increased significantly in group D 60 minutes, 90 minutes and 120 minutes of OLV, and 30 minutes after recovery of bilateral lung ventilation (P < 0.05). Cdyn in group D was significantly higher than that in group C at the time of 90 minutes and 120 minutes of OLV (P < 0.05). The staining degree of AQP5 protein at the time of lobectomy of lungs in group D was significantly deeper than that in group C. Compared with group C, the immunohistochemical score of AQP5 protein was significantly higher at the time of lobectomy of lungs in group D (P < 0.05).
Conclusion Dexmedetomidine can mitigate lung injury and improve lung function in patients undergoing radical operation for lung cancer during one-lung ventilation, which is associated with the enhancement of AQP5 expression in lung tissue by reducing the serum concentrations of TNF-α and IL-8. |
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