右美托咪定、丙泊酚和瑞芬太尼对肺癌手术围手术期炎症反应及肺功能的影响。
Effects of dexmedetomide, propofol and remifentanil on perioperative inflammatory response and lung function during lung cancer surgery.
作者信息
Yin Hengming, Cao Lin, Zhao Hongyu, Yang Yongjian
机构信息
Department of Anesthesiology, Qinghai Provincial People's Hospital Xining 810001, Qinghai Province, China.
Department of Anesthesiology, Eastern Theater General Hospital, Qinhuai District Medical Area Nanjing 210002, Jiangsu Province, China.
出版信息
Am J Transl Res. 2021 Apr 15;13(4):2537-2545. eCollection 2021.
OBJECTIVE
To investigate the effects of combined anesthesia with dexmedetomide, propofol and remifentanil on perioperative inflammatory response and pulmonary function in patients with lung cancer.
METHODS
90 patients with lung cancer admitted to our hospital from April 2017 to April 2019 were selected. According to different anesthesia schemes, patients undergoing combined anesthesia with propofol and remifentanil were included in group A (GA), and patients receiving combined anesthesia with dexmedetomidine, propofol and remifentanil were included in group B (GB). The blood gas, pulmonary function index, inflammatory factor level in serum, anesthetic effect and complications were compared between the two groups.
RESULTS
HR indexes at T1 and T2 in GB were significantly lower than those in GA (P<0.001). There was no significant fluctuation in PaCO2 and PaO2 indexes in the two groups at different time points (P>0.05). At T0, T1 and T2, RV/TLC levels in serum increased significantly in the two groups. (MVV-VE)/FEV1 and MVV/FEV levels were significantly decreased (all P<0.05). The fluctuation levels of RV/TLC, (MVV-VE)/FEV1 and MVV/FEV levels in serum of GB were significantly lower than those of GA at T1 and T2 (P<0.05). At T0, T1 and T2, the levels of inflammatory factors in serum were significantly decreased in the two groups (P<0.05), but the levels of inflammatory factors in serum of GB were significantly lower than those of GA at T1 and T2 (P<0.05). The VAS scores of GB were significantly lower than those of GA at 1 hour and 4 hours after operation (P<0.05). Ramsay scores of GB were significantly higher than those of GA at 1 hour and 4 hours after operation (P<0.05). The restlessness score and choking cough score in GB were lower than those in GA (P<0.05). Perioperative complications in GB were better than those in GA (P<0.05).
CONCLUSION
On the basis of propofol and remifentanil anesthesia, the combination of dexmedetomidine for anesthesia induction can achieve satisfactory anesthesia effect. On the basis of propofol and remifentanil anesthesia combined with dexmedetomidine for anesthesia induction, it can significantly inhibit the inflammatory response of lung cancer patients during perioperative period and it can more effectively stabilize the blood gas microcirculation and lung function of patients.
目的
探讨右美托咪定、丙泊酚和瑞芬太尼联合麻醉对肺癌患者围手术期炎症反应及肺功能的影响。
方法
选取2017年4月至2019年4月我院收治的90例肺癌患者。根据不同麻醉方案，丙泊酚和瑞芬太尼联合麻醉的患者纳入A组（GA组），右美托咪定、丙泊酚和瑞芬太尼联合麻醉的患者纳入B组（GB组）。比较两组患者的血气、肺功能指标、血清炎症因子水平、麻醉效果及并发症。
结果
GB组T1和T2时的心率（HR）指标显著低于GA组（P<0.001）。两组不同时间点的动脉血二氧化碳分压（PaCO2）和动脉血氧分压（PaO2）指标无明显波动（P>0.05）。在T0、T1和T2时，两组血清残气量/肺总量（RV/TLC）水平均显著升高，每分通气量-静息每分钟通气量/第一秒用力呼气量（MVV-VE）/FEV1和MVV/FEV水平均显著降低（均P<0.05）。GB组血清RV/TLC、（MVV-VE）/FEV1和MVV/FEV水平在T1和T2时的波动幅度显著低于GA组（P<0.05）。在T0、T1和T2时，两组血清炎症因子水平均显著降低（P<0.05），但GB组血清炎症因子水平在T1和T2时显著低于GA组（P<0.05）。GB组术后1小时和4小时的视觉模拟评分（VAS）显著低于GA组（P<0.05）。GB组术后1小时和4小时的Ramsay评分显著高于GA组（P<0.05）。GB组的躁动评分和呛咳评分低于GA组（P<0.05）。GB组围手术期并发症优于GA组（P<0.05）。
结论
在丙泊酚和瑞芬太尼麻醉基础上，联合右美托咪定进行麻醉诱导可取得满意的麻醉效果。在丙泊酚和瑞芬太尼麻醉联合右美托咪定进行麻醉诱导的基础上，可显著抑制肺癌患者围手术期的炎症反应，更有效地稳定患者的血气微循环及肺功能。
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