南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (07): 1013-1017.doi: 10.12122/j.issn.1673-4254.2020.07.15

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右美托咪定联合肺保护性通气策略可减轻单肺通气食管癌根治术患者的肺损伤

龚 拯，龙小毛，韦慧君，唐 莹，栗 俊，马 利，余 军   

  • 出版日期:2020-07-20 发布日期:2020-07-20
  • 基金资助:

Dexmedetomidine combined with protective lung ventilation strategy provides lung protection in patients undergoing radical resection of esophageal cancer with one-lung ventilation

  

  • Online:2020-07-20 Published:2020-07-20

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摘要： 目的 探讨右美托咪定联合肺保护性通气策略对单肺通气（OLV）食管癌患者肺损伤保护作用的影响。方法 选择我院行外科手术单肺通气食管癌患者40例，按随机数字表法将其随机分为肺保护性通气策略组（F）和右美托咪定联合肺保护性通气 策略组（DF），每组20例。F group在麻醉过程中单纯采用肺保护性通气策略，DFgroup于麻醉诱导前10 min 开始静脉泵注盐酸右美托咪定0.3 μg/kg/h，并维持至手术结束，同时术中联合肺保护性通气策略。于术前双肺通气时（T0），OLV开始30 min（T1）、OLV后90 min（T2）和术毕（T3）四个时间点采集患者的桡动脉血5 mL，比较两组各时点的超氧化物歧化酶、丙二醛、肿瘤坏死因子α和白介素6的表达水平，以及动脉血氧分压、氧合指数和肺顺应性指标。结果 超氧化物歧化酶和白介素6在两组间的变化趋势有统计学意义（P<0.05），且在T1、T2和T3时间点，DF组的超氧化物歧化酶水平均高于F group，白介素6水平均低于F group，差异有统计学意义（P<0.05）。动脉氧分压、氧合指数和肺顺应性在两组间的变化趋势有统计学意义（P<0.05），且在T1、T2和T3时间点，DF组的PaO2、氧合指数和肺顺应性水平均高于F组，差异有统计学意义（P<0.05）。结论 右美托咪定联合肺保护性通气策略可以通过抗炎与抗氧化应激反应减少单肺通气食管癌患者围术期的肺脏损伤，改善患者的肺脏功能，降低了外科治疗对患者造成的不良影响。

关键词: 右美托咪定, 肺保护性通气策略, 食管癌, 围术期, 肺脏保护

Abstract: Objective To investigate the effect of dexmedetomidine combined with pulmonary protective ventilation against lung injury in patients undergoing surgeries for esophageal cancer with one-lung ventilation (OLV). Methods Forty patients with undergoing surgery for esophageal cancer with OLV were randomly divided into pulmonary protective ventilation strategy group (F group) and dexmedetomidine combined with protective ventilation strategy group (DF group; n=20). In F group, lung protective ventilation strategy during anesthesia was adopte, and in DF group, the patients received intravenous infusion of dexmedetomidine hydrochloride (0.3 μg · kg-1 · h-1) during the surgery starting at 10 min before anesthesia induction in addition to protective ventilation strategy. Brachial artery blood was sampled before ventilation (T0), at 30 and 90 min after the start of OLV (T1 and T2, respectively) and at the end of the surgery (T3) for analysis of superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), arterial oxygenation pressure (PaO2), oxygenation index (OI) and lung compliance (CL). Results At the time points of T1, T2 and T3, SOD level was significantly higher and IL-6 level was significantly lower in the DF group than in F group (P<0.05). The patients in DF group showed significantly higher PaO2, OI and CL index than those in F group at all the 3 time points. Conclusion Dexmedetomidine combined with pulmonary protective ventilation strategy can reduce perioperative lung injury in patients undergoing surgery for esophageal cancer with OLV by suppressing inflammation and oxidative stress to improve lung function and reduce adverse effects of the surgery.

Key words: dexmedetomidine, pulmonary protective ventilation strategy, esophageal cancer, perioperative period, lung protection