盐酸右美托咪定在吸烟患者行肺癌根治术单肺通气中的肺保护作用

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摘要目的探讨盐酸右美托咪定在吸烟患者肺癌根治术单肺通气（OLV）时的肺保护作用。方法选取2017年9月~2018年9月湖北省荆门市第一人民医院择期行肺癌根治术的吸烟患者40例为研究对象，根据随机数字表法分为对照组和观察组，每组20例。麻醉诱导前10 min，观察组静注盐酸右美托咪定1 μg/kg，随后以0.5 μg/（kg·h）的速度输注至手术结束前30 min；对照组以同样的速度输注等容量的生理盐水。于麻醉诱导前（T0）、OLV即刻（T1）、OLV后60 min（T2）、恢复双肺通气后30 min（T3）、术后2 h（T4）取桡动脉血，测定血气指标后计算氧合指数（OI）、呼吸指数（RI）；采用酶联免疫吸附测定法检测T0~T4时血浆肿瘤坏死因子-α（TNF-α）和细胞间黏附分子-1（ICAM-1）浓度；记录术后肺功能发生异常的情况及患者住院时间。结果组内比较：与T0比较，T2~T4时对照组和T2、T3时观察组OI明显降低而RI显著增加（P < 0.05）；T2~T4时两组TNF-α和ICAM-1水平明显升高（P < 0.05）；组间比较：与对照组比较，T2~T4时观察组OI明显增加而RI显著降低（P < 0.05）；T2~T4时观察组TNF-α和ICAM-1水平明显降低（P < 0.05）。与对照组比较，观察组术后低氧血症及肺部感染发生率显著降低，患者住院时间明显缩短（P < 0.05）。结论盐酸右美托咪定可提高OLV时肺的换气及氧合功能，对肺起到保护作用，且减少炎症等不良反应的发生，缩短住院时间。

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	刘荣莉杨昌明▲ 王婵向龙泉袁振武肖迪张琴

关键词 ：右美托咪定, 单肺通气, 吸烟, 炎症因子

Abstract：Objective To investigate the lung protective effect of Dexmedetomidine Hydrochloride in one lung ventilation (OLV) of smoking patients undergoing lung cancer radical operation. Methods Forty smoking patients who underwent lung cancer radical operation in Jingmen First People′s Hospital in Hubei Province from September 2017 to September 2018 were selected as the study objects. According to the method of random number table, the patients were divided into control group and observation group, 20 cases in each group. In the observation group, 1 μg/kg Dexmedetomidine Hydrochloride was intravenously injected 10 min before anesthesia induction, and then 0.5 μg/(kg·h) was infused to 30 min before the end of operation. The control group was infused with the same volume of saline at the same speed. Before anesthesia induction (T0), immediately after OLV (T1), 60 min after OLV (T2), 30 min after recovery of bipulmonary ventilation (T3), and 2 h after operation (T4), the radial artery blood was taken, and the oxygenation index (OI) and respiratory index (RI) were calculated after the measurement of blood gas index; the concentrations of tumor necrosis factor-α (TNF-α) and intercellular adhesion molecule-1 (ICAM-1) were measured by enzyme-linked immunosorbent assay; the abnormal pulmonary function and the length of stay were recorded. Results Intra-group comparison: compared with T0, the control group at T2-T4 and the observation group at T2 and T3 the OI reduced and the RI increased significantly (P < 0.05); at T2-T4, the levels of TNF-α and ICAM-1 in the two group were significant increased (P < 0.05). Comparison between groups: compared with the control group, the OI of the observation group increased significantly and the RI decreased significantly at T2-T4 (P < 0.05); TNF-α and ICAM-1 levels in the observation group at T2-T4 significantly reduced (P < 0.05). Compared with the control group, the incidence of hypoxemia and pulmonary infection in the observation group was significantly reduced, and the length of stay was significantly shortened (P < 0.05). Conclusion Dexmedetomidine Hydrochloride can improve the ventilation and oxygenation function of the lung in OLV, protect the lung, reduce the incidence of inflammation and adverse reactions, and shorten the hospital stay.

Key words： Dexmedetomidine One lung ventilation Smoking Inflammatory factors

基金资助:湖北省卫生与计划生育委员会科研项目（WJ20 17M237）；
湖北省荆门市科技计划项目（YFYB2017007）。

通讯作者: ▲通讯作者

作者简介: 刘荣莉（1981-），女，副主任医师；研究方向：胸科麻醉。

引用本文:

刘荣莉杨昌明▲ 王婵向龙泉袁振武肖迪张琴. 盐酸右美托咪定在吸烟患者行肺癌根治术单肺通气中的肺保护作用[J]. 中国医药导报, 2020, 17(16): 101-104,115.
LIU Rongli YANG Changming▲ WANG Chan XIANG Longquan YUAN Zhenwu XIAO Di ZHANG Qin. The lung protective effect of Dexmedetomidine Hydrochloride in one lung ventilation of smoking patients undergoing lung cancer radical operation. 中国医药导报, 2020, 17(16): 101-104,115.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I16/101

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