右美托咪定对胸腔镜食管癌根治术患者血清炎性因子的影响
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摘要
目的探讨右美托咪定(Dex)对胸腔镜食管癌(EC)根治术患者血清炎性因子的影响。方法选择2016年1月至2017年11月我院在胸腔镜下行EC根治术的58例患者为研究对象,随机分为观察组和对照组,每组29例。两组患者麻醉诱导后纤维支气管镜定位行双腔管气管插管,单肺控制呼吸。观察组泵入Dex 1μg/kg,对照组泵入生理盐水0. 5 ml/kg,术后给予自控镇痛泵。在麻醉诱导前(T_0)、手术结束时(T_1)、术后24 h (T_2)、术后72 h (T_3)测量患者平均动脉压(MAP)、心率(HR),采集颈内静脉血标本,采用酶联免疫吸附法(ELISA)检测炎性因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)。结果在T_1时,观察组患者M AP、HR低于对照组(P <0. 05),T_1～T_3时,观察组血清TNF-α、IL-1β、IL-6低于对照组(P <0. 05)。结论 Dex能够有效改善胸腔镜EC根治术患者围术期炎症反应,维持围术期血流动力学稳定。
Objective To explore the effect of dexmedetomidine (Dex) on serum inflammatory cytokines in patients undergiong thoracoscopic radical resection of esophageal carcinoma (EC). Methods A total of 58 patients with esophageal carcinoma (EC) in our hospital from January 2016 to November 2017 receiving thoracoscopic radical resection of EC were included in the study and randomized into observation group and control group,29 cases in each group. After anesthesia induction,the double-lumen tube tracheal intubation was performed under the location of fiber bronchoscope. Respiration was controlled by single lung. Patients in observation group were given 1 μg/kg Dex,while the patients in control group were given 0. 5 ml/kg normal saline. Patients were given patient-controlled analgesia pump after operation. The levels of M AP and HR were measured before anesthesia induction (T_0) and at 0 h,24 h and 72 h after operation (T_1,T_2 and T_3),and the internal jugular venous blood was collected at the same time. The levels of IL-1β,IL-6 and TNF-α were detected by ELISA. Results The levels of M AP and HR in observation group were lower than those in control group at T1 (P < 0. 05),and the levels of serum IL-1β,IL-6,and TNF-α in observation group were lower than those in control group at T_1,T_2 and T_3 (P < 0. 05). Conclusion Dex can effectively improve the perioperative inflammatory reaction in patients undergoing thoracoscopic radical resection of EC,and maintain the stability of perioperative hemodynamics.
Objective To explore the effect of dexmedetomidine (Dex) on serum inflammatory cytokines in patients undergiong thoracoscopic radical resection of esophageal carcinoma (EC). Methods A total of 58 patients with esophageal carcinoma (EC) in our hospital from January 2016 to November 2017 receiving thoracoscopic radical resection of EC were included in the study and randomized into observation group and control group,29 cases in each group. After anesthesia induction,the double-lumen tube tracheal intubation was performed under the location of fiber bronchoscope. Respiration was controlled by single lung. Patients in observation group were given 1 μg/kg Dex,while the patients in control group were given 0. 5 ml/kg normal saline. Patients were given patient-controlled analgesia pump after operation. The levels of M AP and HR were measured before anesthesia induction (T_0) and at 0 h,24 h and 72 h after operation (T_1,T_2 and T_3),and the internal jugular venous blood was collected at the same time. The levels of IL-1β,IL-6 and TNF-α were detected by ELISA. Results The levels of M AP and HR in observation group were lower than those in control group at T1 (P < 0. 05),and the levels of serum IL-1β,IL-6,and TNF-α in observation group were lower than those in control group at T_1,T_2 and T_3 (P < 0. 05). Conclusion Dex can effectively improve the perioperative inflammatory reaction in patients undergoing thoracoscopic radical resection of EC,and maintain the stability of perioperative hemodynamics.
引文
[1]岳光成,张艳锋,苏文中.刍议腔镜食管癌根治术在食管癌治疗中的临床应用效果[J].中国医药指南,2015,13(21):208-209.
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[6]冯文广,姜伟,宋国军.右美托咪定联合丙泊酚对脑外伤麻醉患者炎性因子及血流动力学影响[J].创伤与急危重病医学,2018,6(6):406-407,409.
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[9]张隆盛,张欢楷,林耿彬,等.右美托咪定复合舒芬太尼对胸腔镜肺叶切除患者术后镇痛的影响[J].实用医学杂志,2018,34(3):453-456.
[10]刘铭,谢平.右美托咪定对老年胃肠肿瘤根治术围术期脑氧代谢及术后认知功能的影响[J].南昌大学学报:医学版,2014,59(8):66-69.
[11]郑静,张红芹,张劲.盐酸右美托咪啶对老年腹腔镜手术患者术后炎性因子及早期认知功能的影响[J].临床合理用药杂志,2016,9(3):19-21.
[12]洪洪,李成辉.单肺通气和低氧血症研究进展[J].中国医药,2017,12(5):796-798.
[13]Joanna W.Integrative review:diagnosis and prevention of postopera-tive cognitive dysfunction[J].Nursing Res,2015,64(2):E24.
[14]黄威,叶靖,秦再生.压控反比通气对胸腔镜手术患者单肺通气时呼吸功能的影响[J].实用医学杂志,2018,34(15):2518-2521.
[15]Liu ZX,Xu FY,Liang X,et al.Efficacy of dexmedetomidine on postoperative shivering:a meta-analysis of clinical trials[J].Can J Anaesth,2015,62(7):816-829.
[16]刘良,杨立信,徐志云.全胸腔镜食管癌根治术对患者术后肺功能及炎性因子的影响[J].海南医学院学报,2016,22(18):2136-2138,2142.
[17]熊熠,谈辉,朱芳,等.右美托咪定对食管癌根治术患者围手术期肺动态顺应及炎性应激反应的影响[J].吉林医学,2017,38(11):2097-2098.
[18]宋直雷,洪道先,张晗,等.右美托咪定对食管癌根治术患者炎性因子的影响[J].中华实用诊断与治疗杂志,2014,28(4):378-380.
[19]王南,黄泽清.盐酸右美托咪定联合单肺通气前间断通气对肺癌根治术患者血浆炎性因子及肺功能影响[J].临床军医杂志,2018,46(3):263-266,271.
[20]卞清明,许仄平,王丽君,等.右美托咪定对胸科手术患者氧合及氧化应激反应的影响[J].华北理工大学学报:医学版,2017,19(6):447-452.
[21]Green D,Balard C,Kunst G.Depth of anaesthesia optimization and postoperative cognitive dysfunction[J].Br J Anaesth,2015,114(2):343-344.
[2]罗云梅.胸外科单肺通气手术封堵支气管导管与双腔气管导管技术运用的临床效果对比分析[J].浙江创伤外科,2017,22(3):486-487.
[3]张卫花.持续泵注右美托咪定对腹腔镜手术患者血液动力学及麻醉质量的影响[J].现代实用医学,2015,27(12):1604-1605.
[4]王伟,包晓航,张瑗,等.右美托咪定持续泵注对不同年龄全麻患者镇静效果及血流动力学影响[J].局解手术学杂志,2016,25(9):673-676.
[5]董金春,王胜斌,徐四七,等.右美托咪定联合利多卡因静脉输注对全麻下子宫切除患者炎性因子的影响[J].实用医学杂志,2018,34(5):820-823,827.
[6]冯文广,姜伟,宋国军.右美托咪定联合丙泊酚对脑外伤麻醉患者炎性因子及血流动力学影响[J].创伤与急危重病医学,2018,6(6):406-407,409.
[7]赵津津,吴敬彰,史双友,等.右美托咪定行使肺保护作用的分子机制[J].实用医学杂志,2017,33(17):2834-2838.
[8]滕成玲,赵玉,吕德珍.右美托咪定联合依达拉奉对老年全髋关节置换术患者术后谵妄的影响[J].中国医药,2017,12(8):1235-1238.
[9]张隆盛,张欢楷,林耿彬,等.右美托咪定复合舒芬太尼对胸腔镜肺叶切除患者术后镇痛的影响[J].实用医学杂志,2018,34(3):453-456.
[10]刘铭,谢平.右美托咪定对老年胃肠肿瘤根治术围术期脑氧代谢及术后认知功能的影响[J].南昌大学学报:医学版,2014,59(8):66-69.
[11]郑静,张红芹,张劲.盐酸右美托咪啶对老年腹腔镜手术患者术后炎性因子及早期认知功能的影响[J].临床合理用药杂志,2016,9(3):19-21.
[12]洪洪,李成辉.单肺通气和低氧血症研究进展[J].中国医药,2017,12(5):796-798.
[13]Joanna W.Integrative review:diagnosis and prevention of postopera-tive cognitive dysfunction[J].Nursing Res,2015,64(2):E24.
[14]黄威,叶靖,秦再生.压控反比通气对胸腔镜手术患者单肺通气时呼吸功能的影响[J].实用医学杂志,2018,34(15):2518-2521.
[15]Liu ZX,Xu FY,Liang X,et al.Efficacy of dexmedetomidine on postoperative shivering:a meta-analysis of clinical trials[J].Can J Anaesth,2015,62(7):816-829.
[16]刘良,杨立信,徐志云.全胸腔镜食管癌根治术对患者术后肺功能及炎性因子的影响[J].海南医学院学报,2016,22(18):2136-2138,2142.
[17]熊熠,谈辉,朱芳,等.右美托咪定对食管癌根治术患者围手术期肺动态顺应及炎性应激反应的影响[J].吉林医学,2017,38(11):2097-2098.
[18]宋直雷,洪道先,张晗,等.右美托咪定对食管癌根治术患者炎性因子的影响[J].中华实用诊断与治疗杂志,2014,28(4):378-380.
[19]王南,黄泽清.盐酸右美托咪定联合单肺通气前间断通气对肺癌根治术患者血浆炎性因子及肺功能影响[J].临床军医杂志,2018,46(3):263-266,271.
[20]卞清明,许仄平,王丽君,等.右美托咪定对胸科手术患者氧合及氧化应激反应的影响[J].华北理工大学学报:医学版,2017,19(6):447-452.
[21]Green D,Balard C,Kunst G.Depth of anaesthesia optimization and postoperative cognitive dysfunction[J].Br J Anaesth,2015,114(2):343-344.