Xie Yang, Jiang Wenqiang, Zhao Lihong, Wu Yifan, Xie Hong
Department of Anesthesiology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital Suzhou, Jiangsu Province, China.
Department of Anesthesiology and Critical Care, The Second Affiliate Hospital of Soochow University Suzhou, Jiangsu Province, China.
Int J Clin Exp Pathol. 2020 Oct 1;13(10):2544-2553. eCollection 2020.
To investigate the effects of dexmedetomidine on perioperative inflammation and lung protection in elderly patients undergoing thoracoscopic radical resection of lung cancer.
A total of 116 elderly patients undergoing elective radical resection of lung cancer in the Second Affiliate Hospital of Soochow University were selected and divided into two groups by random number table method, 58 cases in each group. Observation group was given 1 μg/kg loading dose of dexmedetomidine by continuously intravenous pump for 10 min before anesthesia induction, which was maintained at a rate of 0.3 μg/(kg·h) until 20 min before the end of operation. Control group was given equal volume of normal saline. Heart rate, mean arterial pressure, and alveolar-arterial oxygen pressure difference (P(A-a)O) were measured and recorded respectively at before anesthesia induction (T0), immediately after endotracheal intubation (T1), 1 h after one-lung ventilation (T2) and 10 min before the end of operation (T3).
Compared with control group, heart rate, P(A-a)O, interleukin-6, interleukin-8 and malondialdehyde levels at T1-T3 in observation group were significantly lower; the superoxide dismutase level was significantly higher (all P<0.05), and alveolar damage index of quantitative assessment and apoptotic index at T3 in observation group were significantly lower (P<0.05). The incidence of postoperative pulmonary complications was 3.4% in observation group and 25.8% in control group (P<0.05). The postoperative awake and spontaneous breathing recovery time in the observation group was significantly shorter compared with control group (P<0.05). There was no significant difference in mean arterial pressure at each time point between the two groups (P>0.05).
Dexmedetomidine can reduce inflammatory response and oxidative stress response in elderly patients undergoing radical resection of lung cancer, and reduce the occurrence of postoperative pulmonary complications, thus playing a role in lung protection.
探讨右美托咪定对老年肺癌患者行胸腔镜根治性切除术中围手术期炎症及肺保护的影响。
选取苏州大学附属第二医院116例行择期肺癌根治性切除术的老年患者，采用随机数字表法分为两组，每组58例。观察组在麻醉诱导前10 min通过持续静脉泵给予1 μg/kg负荷剂量的右美托咪定，持续10 min，然后以0.3 μg/(kg·h)的速率维持至手术结束前20 min。对照组给予等体积的生理盐水。分别于麻醉诱导前（T0）、气管插管后即刻（T1）、单肺通气1 h后（T2）及手术结束前10 min（T3）测量并记录心率、平均动脉压及肺泡-动脉血氧分压差（P(A-a)O）。
与对照组相比，观察组T1-T3时的心率、P(A-a)O、白细胞介素-6、白细胞介素-8及丙二醛水平显著降低；超氧化物歧化酶水平显著升高（均P<0.05），观察组T3时定量评估的肺泡损伤指数及凋亡指数显著降低（P<0.05）。观察组术后肺部并发症发生率为3.4%，对照组为25.8%（P<0.05）。观察组术后清醒及自主呼吸恢复时间较对照组显著缩短（P<0.05）。两组各时间点的平均动脉压差异无统计学意义（P>0.05）。
右美托咪定可减轻老年肺癌根治性切除患者的炎症反应和氧化应激反应，减少术后肺部并发症的发生，从而起到肺保护作用。
