摘要
目的:考察食管癌开胸手术过程中,术前给予氯胺酮联合地塞米松对肺损伤的保护作用。方法:选择60例行单肺通气开胸手术的食管癌患者,按随机数字表法分为4组:空白组(S组)、氯胺酮组(K组)、地塞米松(D组)以及氯胺酮联合地塞米松组(KD组),术后均采用硬膜外自控镇痛(PCEA)。记录4组患者术前30 min(T0)、单肺通气(OLV)后60 min(T1)、OLV后120 min(T2)、恢复双肺通气后2 h(T3)各时点的白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α浓度、血气分析中呼吸指数(RI)值变化、术后48 h镇痛效果及不良反应情况。结果:4组患者血压、心率差异无统计学意义(P>0.05),与T0比较,T1、T2、T3时间点RI值升高;与KD组比较,K、D、S组T2、T3时点RI值均增高;血清IL-6、IL-8浓度与T0比较,T1、T2、T3时间点血清IL-6、IL-8浓度均升高,差异有统计学意义(P<0.05);与S组比较,在T1、T2、T3时点D、K、KD组血清IL-6、IL-8浓度均较低,差异有统计学意义(P<0.05);与KD组比较,在T2、T3时点D、K组血清IL-6、IL-8浓度较高,差异有统计学意义(P<0.05);D组与K组血清IL-6、IL-8浓度比较,差异无统计学意义(P>0.05)。4组血清样本TNF-α浓度均低于最低检测浓度;与KD组比较,K、D、S组48 h内术后镇痛视觉模拟评分(VAS)及Prince-Henry评分均较高,差异有统计学意义(P<0.05);与D、S、K组比较,KD组术后PCEA按压次数及镇痛药总用量减少,差异有统计学意义(P<0.05),术后恶心/呕吐发生率低(P<0.05);4组术后谵妄发生率比较,差异无统计学意义(P>0.05)。结论:氯胺酮联合地塞米松预防性用于手术前,能减少炎症介质的释放,降低RI值,增强PCEA镇痛效果,对肺损伤有一定的保护作用。
OBJECTIVE： To observe the protective effect of ketamine and dexamethasone on lung injury in esophageal cancer thoracotomy. METHODS： 60 patients with one-lung ventilation thoracotomy were randomly divided into 4 groups： blank group （group S）, ketamine group （group K）, dexamethasone group （group D） and ketamine and dexamethasone group （group KD） by number. After surgery, the patient-controlled epidural analgesia （PCEA） was used to record the concentrations of IL-6, IL-8, TNF-α with the time point of preoperative 30 min （To）, 60 min after one-lung ventilation （OLV） （Tl）, 120 min after the OLV （T2）, 2 h after restore double-lung ventilation （T3）, the changes of respiratory index （RI） in blood gas analysis and the analgesic effect and adverse reactions in 48 h after treatment. RESULTS： There was no obvious difference between the blood pressure and heart rate in 4 groups （P〉0.05）. Compared with To, the RI values in T1, T2 and T3 were increased; compared with group KD, the RI values in T2 and T3 in group K, group D and group S were increased; compared with TO, the concentrations of IL-6 and IL-8 in T1, T2 and T3 were increased （P〈0.05） ; compared with group S, the concentrations of IL-6 and IL-8 in T1, T2 and T3 in group D, group F and group KD were decreased （P〈0.05） ; compared with group KD, the concentrations of IL-6 and IL-8 in T2 and T3 in group D and group K were higher （P〈0.05）, with statistical significance （P〈0.05） ; there was no significant difference between group D and group K （P〉0.05）. The concentration of TNF-α in 4 groups was lower than minimum detectable concentrations; com- pared with group KD, the scores of analgesia visual analogue scale （VAS） and Prince-Henry in postoperative 48 h in group K and group S were higher （P〈0.05） ; compared with group D, group S and group K, the total number of press PCEA and the total amount of analgesic in group KD were decreased （P〈0.05） and the incidence of postope
出处
《中国药房》
CAS
北大核心
2015年第20期2828-2831,共4页
China Pharmacy
关键词
氯胺酮
地塞米松
单肺通气
炎症介质
肺保护
Ketamine
Dexamethasone
One-lung ventilation
Inflammatory mediator
Lung protection
