联合应用右美托咪定与远隔缺血预处理对胸腔镜肺部手术的肺保护作用及机制研究

摘要

Objective To investigate the effect and mechanism of dexmedetomidine combined with remote ischemic preconditioning(RIPC) on the lung injury in patients undergoing thoracoscopic thoracic surgery.Methods Eighty patients,scheduled for thoracoscopic thoracic operation were randomly divided into 4 groups(n=20 each group) using a random number table: RIPC group(group A), dexmedetomidine group(group B), RIPC combined with dexmedetomidine group(group C) and control group(group D).At 0 min(T0), 30 min(T1), 1h(T2) and 2 h(T3) of one-lung ventilation(OLV), blood samples were obtained for blood gas analysis.Oxygenation index(OI), respiratory index(RI) and intrapulmonary shunt fraction(QS/QT) were calculated and plasma concentrations of tumor necrosis faetor-α(TNF-α), interleukin-6(IL-6) and malondialdehyde(MDA) were detected.Results The RI and QS/QT of the four groups were increased at T1-T2 and then decreased at T3, and these at T3 all were higher than at T0.But OI of the four groups was decreased at T1-T2 and then increased at T3, and OI at T3 was lower than at T0.The differences among the four groups, time points,interaction of groups time points were statistically significant(P<0.05).The levels of TNF-α, IL-6 and MDA of the four groups were increased at T1-T2 and then decreased at T3, and those at T3 all were far higher than at T0.The differences among the four groups, time points,interaction of groups time points were statistically significant(P<0.05).Conclusion Dexmedetomidine combined with RIPC could attenuate the lung injury during one-lung ventilation in patients undergoing thoracoscopic thoracic surgery, and the mechanisms were related with inhibiting inflammatory responses, reducing airway acidification and reducing pulmonary shunt synergistically.%目的 探讨联合应用右美托咪定与远隔缺血预处理对胸腔镜肺部手术的肺保护作用及其可能的机制.方法 将80例胸腔镜肺部手术患者根据处理方法分为4组各20例:缺血预处理组(A组)、右美托咪定组(B组)、联合应用右美托咪定与远隔缺血预处理组(C组)及常规麻醉的空白对照组(D组),于术中单肺通气即刻(T0)、30 min(T1)、1 h(T2)和2 h(T3)行血气分析计算氧合指数(oxygenation index,OI)、呼吸指数(respiratory index,RI)及肺内分流率(intrapulmonary shunt fraction,QS/QT),并测定血浆内肿瘤坏死因子α(tumor necrosis faetor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)、丙二醛(malondialdehyde,MDA)的浓度.结果 4组RI、QS/QT在T1~T2时升高T3时下降,但T3时高于T0,而OI在T1~T2时下降T3时上升,且T3时低于T0,4组在组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05).4组TNF-α、IL-6、MDA在T1~T2时升高T3时下降,但T3时远高于T0 ,4组在组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05).结论 联合应用右美托咪定与远隔缺血预处理可减轻胸腔镜肺部手术单肺通气时的肺损伤,其机制可能与两者协同发挥抑制炎性反应、降低氧化应激程度以及降低肺内分流等作用有关.