摘要
目的分析开胸食管癌根治术患者在进行单肺通气时给予远程缺血预处理联合右美托咪啶对肺组织损伤的保护意义。方法将80例行开胸食管癌根治术患者按随机数字表法分为对照组和观察组，每组40例。观察组在完成气管插管后行远程缺血预处理，同时以负荷剂量右美托咪啶（1．0μg／kg）静脉滴注15min，再以0．5μg／（kg·h）维持静脉滴注至手术完毕；对照组未行远程缺血预处理，只输注等量的0．9％氯化钠。分别于单肺通气即刻（T1）、30min（T2）、1h（T3）、2h（T4）行血气分析，计算氧合指数和呼吸指数，并测定血浆肿瘤坏死因子（TNF）-α、白细胞介素（IL）-1β和IL-10水平。在T1、T3、T4时收集患者呼出气冷凝液检测pH值。结果与T1时相比，两组T2-4时的呼吸指数均增高（对照组：1．16±0．12、1．02±0．10、0．97±0．12比0．49±0．06；观察组：0．84±0．15、0．72±0．12、0．65±0．10比0．48±0．08），氧合指数均减少[对照组：（287．1±21．8）、（306．8±35．2）、（312．9±25．5）mmHg（1mmHg=0．133kPa）比（426．5±39．0）mmHg；观察组：（335．0±34．7）、（341．1±41．3）、（359．1±38．8）mmHg比（433．6±23．8）mmHg]，差异有统计学意义（P〈0．05）；而与对照组同时间点相比，观察组T2-4时呼吸指数均增高，氧合指数均减少，差异有统计学意义（P〈0．05）。与T1时相比，两组T3-4时TNF-α、IL-1β水平增高[对照组：（31．4±6．7）、（38．3±7．2）μg／L比（16．2±5．1）μg/L，（7．2±1．6）、（12．3±4．2）μg/L比（3．0±0．7）μg/L；观察组：（21．7±5．4）、（23．4±5．1）μg/L比（16．3±4．7）μg/L，（4．8±0．9）、（6.3±1．6）μg/L比（2．9±0．8）μg/L]，而呼出气冷凝液pH值降低（对照组：6．41±0．23、6．33士0．21比6．93±0．35；观察组：6．79±0．30、6．74±0．33比7．07±0
Objective To investigate the effect of remote ischemic preconditioning （RIPC） combined with dexmedetomidine on the lung injury during one-lung ventilation （OLV） in the patients undergoing thoracic surgery. Methods Eighty ASA physical status I or II patients, scheduled for elective radical operation for esophageal cancer, were randomly divided into 2 groups（40 patients each group） using a random number table： control group and RIPC combined with dexmedetomidine group （ORD group）. In ORD group, 10 min after endotraeheal intubation, RIPC was induced by 3 cycles of 5 rain lower extremity ischemia followed by 5 min reperfusion, and at the same time a loading dose of dexmedetomidine 1.0 μg/kg was infused intravenously over 15min and then dexmedetomidine was infused at a rate of 0.5 μg/（kg·h） until the end of operation. At 0, 30 min, 1 h and 2 h of OLV（T1-4）, blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α （TNF-α）, interleukin （IL）-1β and IL-10.Oxygenation index and respiratory index were calculated. Exhaled breath condensate was collected at T1- T3 and T4, and the pH value was measured. Results The respiratory index at T2-4 in 2 groups were significantly higher than those at T1, control group： 1.16±0.12, 1.02 ± 0.10 and 0.97 ± 0.12 vs. 0.49 ± 0.06, ORD group： 0.84 ±0.15, 0.72 ± 0.12 and 0.65 ± 0.10 vs. 0.48± 0.08, there were statistical differences （P 〈 0.05）. The oxygenation index at T2-4 in 2 groups were significantly lower than those at T1, control group： （287.1 ± 21.8）, （306.8± 35.2） and （312.9 ± 25.5） mmHg （1 mmHg = 0.133 kPa） vs. （426.5 ± 39.0） mmHg, ORD group： （335.0 ± 34.7）, （341.1 ±41.3） and （359.1 ± 38.8） mmHg vs. （433.6 ± 23.8） mmHg, there were statistical differences （P 〈 0.05）. Compared with control group, the respiratory index at T2-4 in ORD group were elevated, the oxygenation index at T2-4 in ORD gr
出处
《中国医师进修杂志》
2016年第1期46-49,共4页
Chinese Journal of Postgraduates of Medicine
关键词
食管癌根治术
单肺通气
缺血预处理
右美托咪啶
Radical resection of esophageal carcinoma
One-lung ventilation
Ischemic preconditioning
Dexmedetomidine
