摘要
目的 探讨右美托咪定对单肺通气患者非通气侧肺损伤的影响.方法 择期全麻下行胸腔镜下肺癌根治术的患者40例,性别不限,年龄18 ～ 64岁,体重指数18～ 25 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组（n=20）：对照组（C组）和右美托咪定组（D组）.气管插管成功并定位良好后,D组经20 min静脉输注右美托咪定0.5 μg/kg,然后以0.5 μg· kg-1·h-1的速率静脉输注至肺叶肿瘤切除即刻;C组静脉输注等容量生理盐水.分别于单肺通气即刻、单肺通气60 min时和单肺通气结束即刻,切取拟切除肺叶肿瘤周边正常肺组织,光镜下观察病理学结果,并进行肺损伤评分,采用Western blot法检测缺氧诱导因子-1（HIF-1）和血红素加氧酶-1（HO-1）的表达水平.结果 与C组比较,D组单肺通气结束即刻非通气侧肺损伤评分降低,非通气侧肺组织HIF-1α和HO-1的表达上调（P＜0.05）.结论 右美托咪定可减轻单肺通气患者非通气侧肺损伤,其机制与上调HIF-1α和HO-1表达有关.
Objective To investigate the effect of dexmedetomidine on the damage to the nonventilated lung in the patients undergoing one-lung ventilation （OLV）.Methods Forty patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective radical surgery for lung cancer under general anesthesia, were randomly divided into either control group （group C） or dexmedetomidine group （group D） with 20 in each group.After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated.After correct positioning was confirmed by fiberoptic bronchoscopy, dexmedetomidine was infused for 20 min as a dose of 0.5 μg/kg, followed by an infusion of 0.5 μg · kg-1 · h-1 until the moment of tumor resection.The equal volume of normal saline was given in group C.Immediately after the beginning of OLV, at 60 min of OLV, and immediately after the end of OLV, the specimens of normal lung tissues around the tumor were obtained for microscopic examination of pathologic changes which were scored, and for determination of the expression of hypoxia-inducible factor-1 alpha （HIF-1α） and heme oxygenase-1 （HO-1） by Western blot.Results Compared with group C, the pathological score was significantly decreased on the non-ventilated side immediately after the end of OLV, and the expression of HIF-1α and HO-1 in the lung tissues on the non-ventilated side was up-regulated in group D （P〈0.05）.Conclusion Dexmedetomidine can mitigate the damage to the non-ventilated lung in the patients undergoing OLV, and the mechanism is associated with up-regulated expression of HIF-1α and HO-1.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2015年第9期1037-1040,共4页
Chinese Journal of Anesthesiology
基金
河南省科技厅项目（122300410068）
关键词
右美托咪啶
呼吸
人工
再灌注损伤
肺
Dexmedetomidine
Respiration,artifical
Resperfusion injury
Lung
