Wang Yuan, Han Hong-Yang, Jia Ying-Ping, Zhao Li-Yuan, Li Ying, Zuo Bian-Jing, Zhang Jie
Department of Anesthesiology, Children's Hospital Affiliated with Zhengzhou University, Zhengzhou, China.
Department of Radiology, Zhengzhou Central Hospital, Zhengzhou, China.
Front Physiol. 2022 May 5;13:799183. doi: 10.3389/fphys.2022.799183. eCollection 2022.
The present study aims to explore the protective effect of nalbuphine combined with dexmedetomidine on the lungs of children with atelectasis who have a foreign body in a bronchus during the perioperative period. A total of 180 patients whose computed tomography scan showed atelectasis and a foreign body in a bronchus were randomly divided into three groups: group C (conventional anesthesia group), group D (dexmedetomidine group), and group N + D (nalbuphine combined with the dexmedetomidine group). The following indicators were recorded: 1) heart rate (HR) and mean arterial pressure (MAP) prior to induction (T), at bronchoscope placement (T), at intubation after surgery (T), at tube removal (T), 10 min after tube removal (T), 20 min after tube removal (T), and at awaking (T); 2) monocyte toll-like receptors (TLRs) TLR⁃2, TLR⁃4, tumor necrosis factor α, interleukin 6, oxygenation index, and the B-line sum at T, T, 2 h (T), and 24 h (T) after tube removal; and 3) hospital stay after surgery. Compared with group C, in group D and group N + D, 1) the HR and MAP at T∼T were lower; 2) the inflammatory factor indicator and B-line sum were lower, and the oxygenation index was higher at T and T; 3) the agitation and cough scores were decreased during tube removal; and 4) the Ramsay sedation score was higher, and ventilator weaning time was shortened at T∼T ( < 0.05). Compared with group D, in group N + D, 1) the inflammatory factor indicator and B-line sum were lower at T; 2) the oxygenation index was higher ( < 0.05). Compared with groups C and D, in group N + D, the length of hospital stay was decreased ( < 0.05). In patients with atelectasis and a foreign body in a bronchus during the perioperative period, nalbuphine combined with dexmedetomidine may be capable of reducing the oxidative stress response, improving the oxygenation index, decreasing the pulmonary fluid content, protecting the lung, and facilitating postoperative recovery.
本研究旨在探讨纳布啡联合右美托咪定对围手术期支气管异物致肺不张患儿肺部的保护作用。选取180例计算机断层扫描显示肺不张且支气管有异物的患儿，随机分为三组：C组（传统麻醉组）、D组（右美托咪定组）和N+D组（纳布啡联合右美托咪定组）。记录以下指标：1）诱导前（T）、支气管镜置入时（T）、术后插管时（T）、拔管时（T）、拔管后10分钟（T）、拔管后20分钟（T）及苏醒时（T）的心率（HR）和平均动脉压（MAP）；2）拔管后T、T、2小时（T）及24小时（T）时的单核细胞Toll样受体（TLR）TLR⁃2、TLR⁃4、肿瘤坏死因子α、白细胞介素6、氧合指数及B线总和；3）术后住院时间。与C组相比，D组和N+D组：1）T∼T时HR和MAP较低；2）T和T时炎症因子指标及B线总和较低，氧合指数较高；3）拔管时躁动和咳嗽评分降低；4）T∼T时Ramsay镇静评分较高，呼吸机撤机时间缩短（<0.05）。与D组相比，N+D组：1）T时炎症因子指标及B线总和较低；2）氧合指数较高（<0.05）。与C组和D组相比，N+D组住院时间缩短（<0.05）。对于围手术期支气管异物致肺不张患儿，纳布啡联合右美托咪定可能能够减轻氧化应激反应，提高氧合指数，降低肺内液体含量，保护肺脏，并促进术后恢复。
