右美托咪定对胸腔镜肺癌根治术患者围手术期炎症反应及氧化应激反应的影响
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摘要
目的观察右美托咪定对胸腔镜肺癌根治术患者围手术期炎症反应及氧化应激反应的影响。方法全麻单肺通气行胸腔镜肺癌根治术的患者100例,随机分为右美托咪定组(A组)和对照组(B组),每组50例。A组麻醉诱导前20 min静脉注射盐酸右美托咪定负荷量1μg·kg-1,15 min输完,随后给予维持量0.5μg·kg-1·h-1,手术结束前20 min停药; B组给予等量0.9%氯化钠溶液。气管插管后5 min (t0)、单肺通气(OLV) 30 min (t1)、OLV60 min (t2)、完成手术时(t3)采静脉血,酶联免疫吸附测定(ELISA)法测血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-8浓度,检测丙二醛(MDA)浓度和超氧化物歧化酶(SOD)水平。行动脉血气分析,计算氧合指数。结果与t0比较,t1-t3两组血清SOD活性、氧合指数均降低,MDA、TNF-α、IL-6及IL-8浓度均升高(P<0.01);与B组比较,A组t1-t3时间点血清SOD活性、氧合指数更高,MDA、TNF-α、IL-6及IL-8浓度更低(P<0.01)。结论右美托咪定可减轻胸腔镜肺癌根治术患者围手术期炎症反应及氧化应激反应。
Objective To investigate the effect of dexemdetomidine on inflammatory response and oxidative stress in patients undergoing thoracoscopic surgery for radical treatment of lung cancer. Methods One hundred patients undergoing thoracoscopic surgery for radical treatment of lung cancer were randomly divided into dexemdetomidine group( group A) and control group( group B)( 50 in each group).They were all implemented one-lung ventilation.Patients in group A were infused dexmedetomidine 1 μg · kg-1 as loading dose 20 minutes before anesthesia induction,which finished in 15 min. Then a maintenance dose of dexmedetomidine was continuous infused at a rate of 0. 5 μg · kg-1·h-1 until 20 min before operation finished.Patients in group B were given the equal volume of 0.9% sodium choride soution as above. Venous blood samples were collected at 5 min after endotracheal intubation( t0),30( t1) and 60 min( t2) of one-lung ventilation,and the end of operation( t3).The serum concentrations of TNF-!,IL-6 and IL-8 were evaluated by ELISA method. The analysis of blood gas was performed and oxygenation index was calculated.The levels of MDA,SOD were also detected. Results Compared with the t0,the activity of SOD decreased,meanwhile,the plasma concentration of MDA,TNF-α,IL-6 and IL-8 increased in both groups at t1-t3( P<0.01).Compared to group B,the activity of SOD were increased in group A at t3,and the plasma concentration of MDA,TNF-α,IL-6 and IL-8 decreased at t1-t3( P<0.01). Conclusion Dexemdetomidine could inhibit inflammatory response and oxidative stress in patients undergoing radical operation of thoracoscopic lung cancer.
Objective To investigate the effect of dexemdetomidine on inflammatory response and oxidative stress in patients undergoing thoracoscopic surgery for radical treatment of lung cancer. Methods One hundred patients undergoing thoracoscopic surgery for radical treatment of lung cancer were randomly divided into dexemdetomidine group( group A) and control group( group B)( 50 in each group).They were all implemented one-lung ventilation.Patients in group A were infused dexmedetomidine 1 μg · kg-1 as loading dose 20 minutes before anesthesia induction,which finished in 15 min. Then a maintenance dose of dexmedetomidine was continuous infused at a rate of 0. 5 μg · kg-1·h-1 until 20 min before operation finished.Patients in group B were given the equal volume of 0.9% sodium choride soution as above. Venous blood samples were collected at 5 min after endotracheal intubation( t0),30( t1) and 60 min( t2) of one-lung ventilation,and the end of operation( t3).The serum concentrations of TNF-!,IL-6 and IL-8 were evaluated by ELISA method. The analysis of blood gas was performed and oxygenation index was calculated.The levels of MDA,SOD were also detected. Results Compared with the t0,the activity of SOD decreased,meanwhile,the plasma concentration of MDA,TNF-α,IL-6 and IL-8 increased in both groups at t1-t3( P<0.01).Compared to group B,the activity of SOD were increased in group A at t3,and the plasma concentration of MDA,TNF-α,IL-6 and IL-8 decreased at t1-t3( P<0.01). Conclusion Dexemdetomidine could inhibit inflammatory response and oxidative stress in patients undergoing radical operation of thoracoscopic lung cancer.
引文
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[11]王英,谢平,张琳,等.P13K/Akt/GSK.3B信号通路在二氮嗪后处理减轻大鼠心肌缺血再灌注损伤中的作用:离体实验[J].中华麻醉学杂志,2014,34(10):1237-1240.
[12]刘春伟,丛洪良,于雪芳,等.P13K-Akt、mira-KATP通道及m PTP在阿托伐他汀后处理减轻大鼠心肌缺血再灌注损伤中的作用[J].天津医药,2015,43(1):46-50.
[13]ESER O,FIDAN H,SAHIN O,et al.The influence of dexme-detomidine on ischemie rat hippoeampus[J].Brain Res,2008,1218(7):250-256.
[14]MEMIS D,HEKIMOGLU S,VTAN I,et al.Effects of midazolam and dexmedetomidine on inflammatory response and gastric intramucosai PH to sepsis,incritically ill patients[J].Br J Anaesth,2007,98(4):550-552.
[2]王武,吴绍芳,潘晓霞,等.多索茶碱对双腔气管插管单肺通气患者术中肺功能的影响[J].医药导报,2016,35(3):276-278.
[3]张丽丽,张野,李云.右美托咪定对食管癌根治术患者单肺通气时肺组织炎症反应的影响[J].中华麻醉学杂志,2017,37(2):147-150.
[4]LI B,LI Y,TIAN S,et al.Anti-inflammatory effects of pefioperative dexmedetomidine administered as an adjunct to general anesthesia:a meta analysis[J].Sei Rep,2015,5(7):12342.
[5]任毅,韩建阁,高伟,等.治疗性高碳酸血症对肺叶切除术患者单肺通气时的肺保护作用[J].中华麻醉学杂志,2016,36(7):776-779.
[6]XIA R,XU J,YIN H,et al.Intravenous infusion of dexmedetomidine combined isoflurane inhalation reduees oxidative stress and potentiates hypoxia pulmonary vasoconstriction during one-lung ventilation in patients[J].Mediators lnflamm,2015,6(3):238041.
[7]LEE S H,KIM N,LEE C Y,et al.Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery:arandomised double.blinded trial[J].Eur J Anaesthesiol,2016,33(4):275-282.
[8]刘德昭,黄品婕,葛缅.罗格列酮对肝移植围术期肺功能的影响[J].临床麻醉学杂志,2014,30(4):317-340.
[9]FANG J,HU F,KE D,et al.N-dimethylsphingosine attenuates myocardial ischemia-reperfusion injury by recruiting regulatory T cells through P13K/Akt pathway in mice[J].Basic Res Cardiol,2016,111(3):32.
[10]张引,金世云,何淑芳,等.JNK信号通路和p38MAPK信号通路在吗啡预处理减轻心力衰竭大鼠心肌缺血再灌注损伤中的作用[J].中华麻醉学杂志,2016,36(2):219-222.
[11]王英,谢平,张琳,等.P13K/Akt/GSK.3B信号通路在二氮嗪后处理减轻大鼠心肌缺血再灌注损伤中的作用:离体实验[J].中华麻醉学杂志,2014,34(10):1237-1240.
[12]刘春伟,丛洪良,于雪芳,等.P13K-Akt、mira-KATP通道及m PTP在阿托伐他汀后处理减轻大鼠心肌缺血再灌注损伤中的作用[J].天津医药,2015,43(1):46-50.
[13]ESER O,FIDAN H,SAHIN O,et al.The influence of dexme-detomidine on ischemie rat hippoeampus[J].Brain Res,2008,1218(7):250-256.
[14]MEMIS D,HEKIMOGLU S,VTAN I,et al.Effects of midazolam and dexmedetomidine on inflammatory response and gastric intramucosai PH to sepsis,incritically ill patients[J].Br J Anaesth,2007,98(4):550-552.
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