右美托咪定对肺癌根治术单肺通气患者血清炎性因子表达及应激反应的影响
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摘要
目的探讨右美托咪定(DEX)对肺癌根治术单肺通气患者血清炎性因子表达及应激反应的影响。方法选择本院2015年7月～2017年6月收治的94例择期行肺癌根治术患者,将其根据治疗方式的不同分为研究组(n=47例)和对照组(n=47例)。研究组于气管插管后10min静脉泵注DEX 1ug/kg,后以0.5ug/(kg·h)的输注速率持续至手术结束前30min,对照组采用同等剂量的生理盐水。观察两组麻醉诱导时即刻(T_0),单肺通气60min后(T_1),手术结束时即刻(T_2)3个时间点炎症因子,包括肾上腺素(E)、去甲肾上腺素(NE)、血清皮质醇(COR)及应激反应指标,包括白细胞介素6(IL-6)、肿瘤坏死因子α(7NF-2)、高敏C反应蛋白(hs-CRP)水平的变化情况。结果两组T_1、T_2血清E、NE、COR水平均明显高于T_0(P<0.05),研究组血清E、NE、COR水平均明显低于对照组(P<0.05)。两组T_1、T_2血清IL-6、TNF-α、hs-CRP水平均高于T_0(P<0.05),研究组血清IL-6、TNF-α、hs-CRP水平均明显低于对照组(P<0.05)。两组单肺通气时间、术中出血量、补液量及24h尿量比较差异无统计意义(P>0.05)。研究组术后苏醒时间及拔管时间均低于对照组,研究组Ramsay镇静评分高于对照组(P<0.05)。结论 DEX可有效降低肺癌根治术患者单肺通气时的炎症因子及术中应激反应指标水平,提高麻醉效果,对促进患者快速康复有积极意义。
Objective To analyze the effect of dexmedetomidine(DEX) on serum inflammatory factor expression and stress response in patients with lung cancer undergoing radical mastectomy. Methods The clinical data of 94 patients undergoing elective lung cancer radical surgery admitted to our hospital from July 2015 to June 2017 were prospectively analyzed. The selected patients were divided into study group(n=47 cases) and control group(n=47 cases), according to different treatment methods. Patients in the study group were intravenously infused with DEX 1 ug/kg 10 minutes after endotracheal intubation, and then continued at an infusion rate of 0.5 ug/kg·h until 30 minutes before the end of surgery. The control group received the same dose of normal saline, the changes of inflammatory factors and stress response indicators at different time points in the two groups were observed. Results At the time of T1 and T2, the levels of serum E, NE and COR in the two groups were significantly higher than those in T0(P<0.05). The serum E, NE and COR levels in the study group were significantly lower than those in the control group( P<0.05). At the time of T1 and T2, serum IL-6, TNF-α and hs-CRP levels in the two groups were significantly higher than those in T0(P<0.05). The serum IL-6, TNF-α, hs-CRP in the study group were significantly lower than those in the control group(P<0.05). There was no significant difference in single lung ventilation time, intraoperative blood loss, fluid volume and 24 h urine volume between the two groups(P>0.05). The postoperative recovery time and extubation time of the study group were significantly lower than those of the control group, and the Ramsay sedation score of the study group was significantly higher than that of the control group(P<0.05). Conclusion DEX in patients undergoing radical mastectomy can effectively reduce the secretion of inflammatory factors during single-lung ventilation, inhibit the inflammatory response, and effectively reduce the level of intraoperative stress response, improve the effect of anesthesia and surgical treatment, improve the quality of postoperative recovery, and have positive significance for promoting rapid recovery of patients' diseases.
Objective To analyze the effect of dexmedetomidine(DEX) on serum inflammatory factor expression and stress response in patients with lung cancer undergoing radical mastectomy. Methods The clinical data of 94 patients undergoing elective lung cancer radical surgery admitted to our hospital from July 2015 to June 2017 were prospectively analyzed. The selected patients were divided into study group(n=47 cases) and control group(n=47 cases), according to different treatment methods. Patients in the study group were intravenously infused with DEX 1 ug/kg 10 minutes after endotracheal intubation, and then continued at an infusion rate of 0.5 ug/kg·h until 30 minutes before the end of surgery. The control group received the same dose of normal saline, the changes of inflammatory factors and stress response indicators at different time points in the two groups were observed. Results At the time of T1 and T2, the levels of serum E, NE and COR in the two groups were significantly higher than those in T0(P<0.05). The serum E, NE and COR levels in the study group were significantly lower than those in the control group( P<0.05). At the time of T1 and T2, serum IL-6, TNF-α and hs-CRP levels in the two groups were significantly higher than those in T0(P<0.05). The serum IL-6, TNF-α, hs-CRP in the study group were significantly lower than those in the control group(P<0.05). There was no significant difference in single lung ventilation time, intraoperative blood loss, fluid volume and 24 h urine volume between the two groups(P>0.05). The postoperative recovery time and extubation time of the study group were significantly lower than those of the control group, and the Ramsay sedation score of the study group was significantly higher than that of the control group(P<0.05). Conclusion DEX in patients undergoing radical mastectomy can effectively reduce the secretion of inflammatory factors during single-lung ventilation, inhibit the inflammatory response, and effectively reduce the level of intraoperative stress response, improve the effect of anesthesia and surgical treatment, improve the quality of postoperative recovery, and have positive significance for promoting rapid recovery of patients' diseases.
引文
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[9] 陶广华,张文龙,刘向六,等.右美托咪定联合乌司他丁对单肺通气肺癌患者血清促炎因子水平的影响[J].山东医药,2017(37):48-51.
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[11] 丁艺,李永录,林雅丽,等.右美托咪定联合参附注射液对单肺通气患者的肺保护作用[J].现代中西医结合杂志,2016,25(13):1372-1374.
[12] 郭琼梅,周长浩,张建波,等.右美托咪定对单肺通气患者肺组织NF-κB表达及血浆TNF-α和ICAM-1水平的影响[J].河北医科大学学报,2016,37(3):301-305.
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[15] 刘光杰,白庆林,李海燕,等.右美托咪定联合丙泊酚对单肺通气患者的肺保护作用[J].中国临床医生杂志,2016,44(2):81-83.
[16] 钟惠,尹亚兰,李英,等.右美托咪定对抑制单肺通气再灌注炎性反应的影响分析[J].临床肺科杂志,2017,22(8):1471-1474.
[17] 王槐青,陆联群,唐恩辉,等.右美托咪定对胸腔镜手术患者单肺通气期间肺内分流和动脉血氧合的影响[J].实用心脑肺血管病杂志,2016,29(4):245-246.
[18] 马小翠,王泓波,唐涛,等.右美托咪定对食管癌根治术患者单肺通气期间氧合作用的影响[J].中国医师进修杂志,2017,37(12):1076-1080.
[19] 陶应军,陶广华,吴畏,等.右美托咪定联合乌司他丁对单肺通气肺叶切除术患者应激反应指标等的影响[J].中国药房,2017,28(35):4943-4947.
[20] 李文建,何学东,钟庆,等.单腔气管导管在食道癌根治术单肺通气的临床评价[J].西部医学,2012,24(8):1536-1538.
[21] 刘文良,余雪美,熊朝晖.右美托咪定对肺癌根治术患者术后镇痛及免疫功能的影响[J].西部医学,2018,30(1):64-67.
[2] 朱焱林,蒋亚欧,肖红波,等.右美托咪定对单肺通气患者动脉血气和炎性因子的影响[J].临床麻醉学杂志,2017,33(11):1070-1073.
[3] 刘玉婷,刘玉革,维拉.右美托咪定对食管癌根治术单肺通气患者血清炎性反应的影响[J].临床麻醉学杂志,2016,32(11):1053-1056.
[4] 郭琼梅,周长浩,陈欢,等.右美托咪定对单肺通气患者血浆 IL-8、IL-10及肺组织 AQP1表达的影响[J].临床麻醉学杂志,2016,32(3):245-247.
[5] 郭琼梅,张莉,魏砚砚,等.右美托咪定对单肺通气患者血浆IL-1β及肺组织AQP4、AQP5表达水平的影响[J].中国医药导报,2017,14(4):58-61.
[6] 赵映辉.右美托咪定、丙泊酚及咪达唑仑辅助硬膜外麻醉的镇静效果比较[J].保健医学研究与实践,2017,14(5):62-64.
[7] Zhou C,Yu Z,Zhen L,et al.Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia:A meta-analysis[J].Journal of International Medical Research,2016,44(6):1182-1202.
[8] 王瑛,郭春燕,陈冬梅,等.右美托咪定对开胸手术单肺通气患者术中血流动力学和炎性因子的影响[J].现代生物医学进展,2016,36(35):6891-6893.
[9] 陶广华,张文龙,刘向六,等.右美托咪定联合乌司他丁对单肺通气肺癌患者血清促炎因子水平的影响[J].山东医药,2017(37):48-51.
[10] 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.
[11] 丁艺,李永录,林雅丽,等.右美托咪定联合参附注射液对单肺通气患者的肺保护作用[J].现代中西医结合杂志,2016,25(13):1372-1374.
[12] 郭琼梅,周长浩,张建波,等.右美托咪定对单肺通气患者肺组织NF-κB表达及血浆TNF-α和ICAM-1水平的影响[J].河北医科大学学报,2016,37(3):301-305.
[13] 丁艺,李永录,林雅丽,等.不同剂量右美托咪定联合参附注射液对成人单肺通气术中患者的影响[J].现代中西医结合杂志,2017,26(17):1927-1929.
[14] Farghaly H S,Mahmoud A M,Abdel-Sater K A.Effect of dexmedetomidine and cold stress in a rat model of neuropathic pain:role of interleukin-6 and tumor necrosis factor-α[J].European Journal of Pharmacology,2016,776(3):139-145.
[15] 刘光杰,白庆林,李海燕,等.右美托咪定联合丙泊酚对单肺通气患者的肺保护作用[J].中国临床医生杂志,2016,44(2):81-83.
[16] 钟惠,尹亚兰,李英,等.右美托咪定对抑制单肺通气再灌注炎性反应的影响分析[J].临床肺科杂志,2017,22(8):1471-1474.
[17] 王槐青,陆联群,唐恩辉,等.右美托咪定对胸腔镜手术患者单肺通气期间肺内分流和动脉血氧合的影响[J].实用心脑肺血管病杂志,2016,29(4):245-246.
[18] 马小翠,王泓波,唐涛,等.右美托咪定对食管癌根治术患者单肺通气期间氧合作用的影响[J].中国医师进修杂志,2017,37(12):1076-1080.
[19] 陶应军,陶广华,吴畏,等.右美托咪定联合乌司他丁对单肺通气肺叶切除术患者应激反应指标等的影响[J].中国药房,2017,28(35):4943-4947.
[20] 李文建,何学东,钟庆,等.单腔气管导管在食道癌根治术单肺通气的临床评价[J].西部医学,2012,24(8):1536-1538.
[21] 刘文良,余雪美,熊朝晖.右美托咪定对肺癌根治术患者术后镇痛及免疫功能的影响[J].西部医学,2018,30(1):64-67.