不同剂量右美托咪定复合舒芬太尼对肺癌根治术后患者炎性细胞因子和认知功能的影响
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摘要
目的:研究不同剂量右美托咪定复合舒芬太尼对肺癌根治术后患者炎性细胞因子和认知功能的影响。方法:选择从2017年1月到2018年6月在四川省遂宁市中心医院接受肺癌根治术治疗的患者135例进行研究。根据随机数字法将患者分成A、B、C三组各45例,各组均实施常规麻醉,而后A组、B组、C组分别给予0.04μg/kg·h的舒芬太尼及不同低剂量(A组:低剂量0.06μg/kg·h,B组:中剂量0.08μg/kg·h,C组:高剂量0.1μg/kg·h)的右美托咪定。对比各组患者入组前(T_0)、术后1 d(T_1)、术后2 d(T_2)的呼吸循环指标、炎性细胞因子水平、简易智力状态检查(MMSE)评分及麻醉恢复室(PACU)评分。结果:各组的收缩压(SBP)、舒张压(DBP)、心率(HR)及呼吸频率(RR)呈现出不同程度的波动变化;B、C两组T1和T2时的SBP、DBP及HR均明显低于A组,且C组又低于B组(P<0.05)。各组T_1和T_2时的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)及白细胞介素-10(IL-10)水平均明显高于T0,且T2又高于T1(P<0.05);B、C两组T_1和T_2时的CRP及TNF-α水平均明显低于A组,且C组又低于B组,而IL-10水平明显高于A组,且C组又高于B组(P<0.05)。各组间在T_0、T_1和T_2时的MMSE评分以及PACU评分相比,差异均无统计学意义(P>0.05)。结论:中剂量的右美托咪定复合舒芬太尼用于对肺癌根治术患者的手术镇痛效果较好,且对患者的炎性细胞因子水平及认知功能的影响较小,用药方式较为安全,可在临床进行推广和应用。
Objective: To study the effects of different doses of dexmedetomidine combined with sufentanil on inflammatory cytokines and cognitive function in patients after radical resection of lung cancer. Methods: 135 patients who were undergone radical resection of lung cancer in Suining Central Hospital of Sichuan Province from January 2017 to June 2018 were selected to carry out research. According to the random number method, the patients were divided into three groups: A group, B group and C group, 45 cases in each group. Each group was given routine anesthesia, and then A group, B group, C group were given 0.04 μg/kg·h sufentanil and different dose(A grou: low dose with 0.06 μg/kg·h, B group:medium dose with 0.08 μg/kg·h, C group: large dose with 0.1 μg/kg·h)dexmetidine. The respiratory cycle indexes, inflammatory cytokine levels, mini-mental state examination(MMSE) score and post-anesthesia care unit(PACU) score were compared in each group before entering the group(T_0), postoperative 1 d(T_1), postoperative2 d(T_2). Results: The systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and respiratory rate(RR) of each group showed varying degrees of fluctuation. The SBP, DBP and HR of B and C two groups at T_1 and T_2 were significantly lower than those of A group, and C group was lower than that of B group(P<0.05). The levels of C reactive protein(CRP), tumor necrosis factor-α(TNF-α) and interleukin-10(IL-10) in each group at T_1 and T_2 were significantly higher than those at T_0, and T_2 was higher than T_1(P<0.05). The levels of CRP and TNF-α of B and C two groups at T_1 and T_2 were significantly lower than those of A group, and C group was lower than B group, while the level of IL-10 was significantly higher than that of A group, and C group was higher than that of B group(P<0.05). There was no significant difference in MMSE score and PACU score between groups at T_0, T_1 and T_2(P>0.05). Conclusion:Medium dose dexmedetomidine combined with sufentanil has better analgesic effect on patients undergoing radical resection of lung cancer. Moreover, it has little effect on inflammatory cytokines levels and cognitive function of patients, the way of drug use is safer,which can be popularized and applied in clinic.
Objective: To study the effects of different doses of dexmedetomidine combined with sufentanil on inflammatory cytokines and cognitive function in patients after radical resection of lung cancer. Methods: 135 patients who were undergone radical resection of lung cancer in Suining Central Hospital of Sichuan Province from January 2017 to June 2018 were selected to carry out research. According to the random number method, the patients were divided into three groups: A group, B group and C group, 45 cases in each group. Each group was given routine anesthesia, and then A group, B group, C group were given 0.04 μg/kg·h sufentanil and different dose(A grou: low dose with 0.06 μg/kg·h, B group:medium dose with 0.08 μg/kg·h, C group: large dose with 0.1 μg/kg·h)dexmetidine. The respiratory cycle indexes, inflammatory cytokine levels, mini-mental state examination(MMSE) score and post-anesthesia care unit(PACU) score were compared in each group before entering the group(T_0), postoperative 1 d(T_1), postoperative2 d(T_2). Results: The systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and respiratory rate(RR) of each group showed varying degrees of fluctuation. The SBP, DBP and HR of B and C two groups at T_1 and T_2 were significantly lower than those of A group, and C group was lower than that of B group(P<0.05). The levels of C reactive protein(CRP), tumor necrosis factor-α(TNF-α) and interleukin-10(IL-10) in each group at T_1 and T_2 were significantly higher than those at T_0, and T_2 was higher than T_1(P<0.05). The levels of CRP and TNF-α of B and C two groups at T_1 and T_2 were significantly lower than those of A group, and C group was lower than B group, while the level of IL-10 was significantly higher than that of A group, and C group was higher than that of B group(P<0.05). There was no significant difference in MMSE score and PACU score between groups at T_0, T_1 and T_2(P>0.05). Conclusion:Medium dose dexmedetomidine combined with sufentanil has better analgesic effect on patients undergoing radical resection of lung cancer. Moreover, it has little effect on inflammatory cytokines levels and cognitive function of patients, the way of drug use is safer,which can be popularized and applied in clinic.
引文
[1]Zhou L,Lan H,Zhou Q,et al.Continuous infusion of high-dose ulinastatin during surgery does not improve early postoperative clinical outcomes in patients undergoing radical lung cancer surgery:A pilot study[J].Thorac Cancer,2016,7(5):581-587
[2]Tan J,Song Z,Bian Q,et al.Effects of volume-controlled ventilation vs.pressure-controlled ventilation on respiratory function and inflammatory factors in patients undergoing video-assisted thoracoscopic radical resection of pulmonary carcinoma[J].J Thorac Dis,2018,10(3):1483-1489
[3]Shimoyama T,Kimura B.Salvage Surgery after Radical Chemotherapy for N3 Non-small Cell Lung Cancer[J].Kyobu Geka,2018,71(3):185-189
[4]Lu J,Liu Z,Xia K,et al.Effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer[J].Int J Clin Exp Med,2015,8(8):14115-1418
[5]Zhen L,Li X,Gao X,et al.Dose determination of sufentanil for intravenous patient-controlled analgesia with background infusion in abdominal surgeries:A random study[J].PLoS One,2018,13(10):e0205959
[6]Sorrieul J,Robert J,Gibory V,et al.Stability of sufentanil and baclofen mixtures for intrathecal analgesia at different concentrations in polypropylene syringes[J].Ann Pharm Fr,2018,76(6):444-452
[7]Santos C,Fernandes C.Intraoperative use of dexmedetomidine in prevention of emergence agitation-a case report[J].Rev Port Cir Cardiotorac Vasc,2018,25(1-2):65-67
[8]Fink DM,Doss GA,Sladky KK,et al.Effect of injection site on dexmedetomidine-ketamine induced sedation in leopard geckos[J].JAm Vet Med Assoc,2018,253(9):1146-1150
[9]严英,劳慧丽.右美托咪啶复合舒芬太尼用于肺癌根治术后静脉自控镇痛的效果[J].浙江医学,2016,38(4):291-293
[10]车舒平,孙夕林,鄢英男,等.肺癌的综合影像诊断进展[J].现代生物医学进展,2018,18(2):392-396
[11]Tian HT,Duan XH,Yang YF,et al.Effects of propofol or sevoflurane anesthesia on the perioperative inflammatory response,pulmonary function and cognitive function in patients receiving lung cancer resection[J].Eur Rev Med Pharmacol Sci,2017,21(23):5515-5522
[12]Cobbe KA,Barford-Cubitt S.Nonclinical Factors Affecting PACUDischarge:A Clinical Audit in a One-Day Surgery Unit[J].J Perianesth Nurs,2018,33(5):676-680
[13]Hu XL,Xu ST,Wang XC,et al.Prevalence of and risk factors for presenting initial respiratory symptoms in patients undergoing surgery for lung cancer[J].J Cancer,2018,9(19):3515-3521
[14]Rankantha A,Chitapanarux I,Pongnikorn D,et al.Risk patterns of lung cancer mortality in northern Thailand[J].BMC Public Health,2018,18(1):1138
[15]Seol KH,Lee JE,Cho JY,et al.Salvage radiotherapy for regional lymph node oligo-recurrence after radical surgery of non-small cell lung cancer[J].Thorac Cancer,2017,8(6):620-629
[16]Hattori A,Matsunaga T,Takamochi K,et al.Surgical resection for clinical-Stage I radiological pure-solid lung cancer that met the current high risk criteria[J].Jpn J Clin Oncol,2017,47(7):630-638
[17]Deng C,Wang X,Zhu Q,et al.Comparison of nalbuphine and sufentanil for colonoscopy:A randomized controlled trial[J].PLoS One,2017,12(12):e0188901
[18]Yu Y,Qi SL,Zhang Y.Role of combined propofol and sufentanil anesthesia in endoscopic injection sclerotherapy for esophageal varices[J].World J Gastroenterol,2017,23(44):7875-7880
[19]Wang C,Datoo T,Zhao H,et al.Midazolam and Dexmedetomidine Affect Neuroglioma and Lung Carcinoma Cell Biology In Vitro and In Vivo[J].Anesthesiology,2018,129(5):1000-1014
[20]Cata JP,Singh V,Lee BM,et al.Intraoperative use of dexmedetomidine is associated with decreased overall survival after lung cancer surgery[J].J Anaesthesiol Clin Pharmacol,2017,33(3):317-323
[21]Wang X,Wang K,Wang B,et al.Effect of Oxycodone Combined With Dexmedetomidine for Intravenous Patient-Controlled Analgesia After Video-Assisted Thoracoscopic Lobectomy[J].J Cardiothorac Vasc Anesth,2016,30(4):1015-1021
[22]Chen Q,Yi B,Ma J,et al.α2-adrenoreceptor modulated FAK pathway induced by dexmedetomidine attenuates pulmonary microvascular hyper-permeability following kidney injury[J].Oncotarget,2016,7(35):55990-56001
[23]Moon T,Tsai JY,Vachhani S,et al.The Use of Intraoperative Dexmedetomidine Is Not Associated With a Reduction in Acute Kidney Injury After Lung Cancer Surgery[J].J Cardiothorac Vasc Anesth,2016,30(1):51-55
[24]Lu Y,Chen RG,Wei SZ,et al.Effect of omega 3 fatty acids on C-reactive protein and interleukin-6 in patients with advanced nonsmall cell lung cancer[J].Medicine(Baltimore),2018,97(37):e11971
[25]Wang X,Huang L,Qu Y,et al.Effects of glutamine on cytokines1L-1 and TNF-αin rehabilitation and prognosis of patients with lobectomy[J].Exp Ther Med,2018,16(3):2303-2308
[26]Vahl JM,Friedrich J,Mittler S,et al.Interleukin-10-regulated tumour tolerance in non-small cell lung cancer[J].Br J Cancer,2017,117(11):1644-1655
[27]Ai D,Xu G,Feng L,et al.Dexmedetomidine does not reduce atrial fibrillation after lung cancer surgery[J].J Cardiothorac Vasc Anesth,2015,29(2):396-401
[28]Lee SH,Kim N,Lee CY,et al.Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery:A randomised double-blinded trial[J].Eur J Anaesthesiol,2016,33(4):275-282
[29]Carr ZJ,Cios TJ,Potter KF,et al.Does Dexmedetomidine Ameliorate Postoperative Cognitive Dysfunction?A Brief Review of the Recent Literature[J].Curr Neurol Neurosci Rep,2018,18(10):64
[30]Xiong B,Shi Q,Fang H.Dexmedetomidine alleviates postoperative cognitive dysfunction by inhibiting neuron excitation in aged rats[J].Am J Transl Res,2016,8(1):70-80
[2]Tan J,Song Z,Bian Q,et al.Effects of volume-controlled ventilation vs.pressure-controlled ventilation on respiratory function and inflammatory factors in patients undergoing video-assisted thoracoscopic radical resection of pulmonary carcinoma[J].J Thorac Dis,2018,10(3):1483-1489
[3]Shimoyama T,Kimura B.Salvage Surgery after Radical Chemotherapy for N3 Non-small Cell Lung Cancer[J].Kyobu Geka,2018,71(3):185-189
[4]Lu J,Liu Z,Xia K,et al.Effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer[J].Int J Clin Exp Med,2015,8(8):14115-1418
[5]Zhen L,Li X,Gao X,et al.Dose determination of sufentanil for intravenous patient-controlled analgesia with background infusion in abdominal surgeries:A random study[J].PLoS One,2018,13(10):e0205959
[6]Sorrieul J,Robert J,Gibory V,et al.Stability of sufentanil and baclofen mixtures for intrathecal analgesia at different concentrations in polypropylene syringes[J].Ann Pharm Fr,2018,76(6):444-452
[7]Santos C,Fernandes C.Intraoperative use of dexmedetomidine in prevention of emergence agitation-a case report[J].Rev Port Cir Cardiotorac Vasc,2018,25(1-2):65-67
[8]Fink DM,Doss GA,Sladky KK,et al.Effect of injection site on dexmedetomidine-ketamine induced sedation in leopard geckos[J].JAm Vet Med Assoc,2018,253(9):1146-1150
[9]严英,劳慧丽.右美托咪啶复合舒芬太尼用于肺癌根治术后静脉自控镇痛的效果[J].浙江医学,2016,38(4):291-293
[10]车舒平,孙夕林,鄢英男,等.肺癌的综合影像诊断进展[J].现代生物医学进展,2018,18(2):392-396
[11]Tian HT,Duan XH,Yang YF,et al.Effects of propofol or sevoflurane anesthesia on the perioperative inflammatory response,pulmonary function and cognitive function in patients receiving lung cancer resection[J].Eur Rev Med Pharmacol Sci,2017,21(23):5515-5522
[12]Cobbe KA,Barford-Cubitt S.Nonclinical Factors Affecting PACUDischarge:A Clinical Audit in a One-Day Surgery Unit[J].J Perianesth Nurs,2018,33(5):676-680
[13]Hu XL,Xu ST,Wang XC,et al.Prevalence of and risk factors for presenting initial respiratory symptoms in patients undergoing surgery for lung cancer[J].J Cancer,2018,9(19):3515-3521
[14]Rankantha A,Chitapanarux I,Pongnikorn D,et al.Risk patterns of lung cancer mortality in northern Thailand[J].BMC Public Health,2018,18(1):1138
[15]Seol KH,Lee JE,Cho JY,et al.Salvage radiotherapy for regional lymph node oligo-recurrence after radical surgery of non-small cell lung cancer[J].Thorac Cancer,2017,8(6):620-629
[16]Hattori A,Matsunaga T,Takamochi K,et al.Surgical resection for clinical-Stage I radiological pure-solid lung cancer that met the current high risk criteria[J].Jpn J Clin Oncol,2017,47(7):630-638
[17]Deng C,Wang X,Zhu Q,et al.Comparison of nalbuphine and sufentanil for colonoscopy:A randomized controlled trial[J].PLoS One,2017,12(12):e0188901
[18]Yu Y,Qi SL,Zhang Y.Role of combined propofol and sufentanil anesthesia in endoscopic injection sclerotherapy for esophageal varices[J].World J Gastroenterol,2017,23(44):7875-7880
[19]Wang C,Datoo T,Zhao H,et al.Midazolam and Dexmedetomidine Affect Neuroglioma and Lung Carcinoma Cell Biology In Vitro and In Vivo[J].Anesthesiology,2018,129(5):1000-1014
[20]Cata JP,Singh V,Lee BM,et al.Intraoperative use of dexmedetomidine is associated with decreased overall survival after lung cancer surgery[J].J Anaesthesiol Clin Pharmacol,2017,33(3):317-323
[21]Wang X,Wang K,Wang B,et al.Effect of Oxycodone Combined With Dexmedetomidine for Intravenous Patient-Controlled Analgesia After Video-Assisted Thoracoscopic Lobectomy[J].J Cardiothorac Vasc Anesth,2016,30(4):1015-1021
[22]Chen Q,Yi B,Ma J,et al.α2-adrenoreceptor modulated FAK pathway induced by dexmedetomidine attenuates pulmonary microvascular hyper-permeability following kidney injury[J].Oncotarget,2016,7(35):55990-56001
[23]Moon T,Tsai JY,Vachhani S,et al.The Use of Intraoperative Dexmedetomidine Is Not Associated With a Reduction in Acute Kidney Injury After Lung Cancer Surgery[J].J Cardiothorac Vasc Anesth,2016,30(1):51-55
[24]Lu Y,Chen RG,Wei SZ,et al.Effect of omega 3 fatty acids on C-reactive protein and interleukin-6 in patients with advanced nonsmall cell lung cancer[J].Medicine(Baltimore),2018,97(37):e11971
[25]Wang X,Huang L,Qu Y,et al.Effects of glutamine on cytokines1L-1 and TNF-αin rehabilitation and prognosis of patients with lobectomy[J].Exp Ther Med,2018,16(3):2303-2308
[26]Vahl JM,Friedrich J,Mittler S,et al.Interleukin-10-regulated tumour tolerance in non-small cell lung cancer[J].Br J Cancer,2017,117(11):1644-1655
[27]Ai D,Xu G,Feng L,et al.Dexmedetomidine does not reduce atrial fibrillation after lung cancer surgery[J].J Cardiothorac Vasc Anesth,2015,29(2):396-401
[28]Lee SH,Kim N,Lee CY,et al.Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery:A randomised double-blinded trial[J].Eur J Anaesthesiol,2016,33(4):275-282
[29]Carr ZJ,Cios TJ,Potter KF,et al.Does Dexmedetomidine Ameliorate Postoperative Cognitive Dysfunction?A Brief Review of the Recent Literature[J].Curr Neurol Neurosci Rep,2018,18(10):64
[30]Xiong B,Shi Q,Fang H.Dexmedetomidine alleviates postoperative cognitive dysfunction by inhibiting neuron excitation in aged rats[J].Am J Transl Res,2016,8(1):70-80