摘要
目的评价右美托咪定对肺叶切除术患者肺组织炎症反应和细胞焦亡相关因子的影响。方法选取2018年11月至2019年11月青岛大学附属医院210例、青岛市市立医院228例需行胸腔镜肺叶切除术患者共438例,采用随机数字表法分为对照组(C组)和右美托咪定组(D组),每组219例。D组于麻醉诱导前10 min静脉输注负荷剂量1.0μg/kg右美托咪定,随后以0.3μg/(kg·h)静脉输注至术毕前30 min,C组静脉输注等容量0.9%氯化钠注射液。麻醉诱导后行双腔气管导管插管单肺通气(OLV),采用纤维支气管镜确定双腔气管导管位置。术中于肺叶离体时取肺组织标本3份,1份采用Western blot法检测肺组织消皮素D(GSDMD)、NOD样受体家族蛋白3(NLRP3)、凋亡相关微粒蛋白(ASC)和半胱天冬酶-1(Caspase-1)的表达;1份计算肺湿干重(W/D)值;1份经HE染色观察肺组织病理情况并作病理学损伤评分。于OLV即刻(T1)、15 min(T2)、30 min(T3)、60 min(T4)和恢复双肺通气1 h(T5)时采集动脉血进行血气分析计算氧合指数。记录患者术后并发症的发生情况及术后住院时间。结果与C组比较,D组肺组织GSDMD、NLRP3、ASC和Caspase-1的表达下调,OLV 15、30、60 min及恢复双肺通气1 h氧合指数均升高(均P<0.05);肺病理学损伤评分、W/D值、术后肺炎、肺不张的发生率降低,术后住院时间缩短(均P<0.05)。结论右美托咪定可改善肺叶切除术患者肺组织炎症反应从而减轻急性肺损伤,其机制可能与抑制肺泡巨噬细胞焦亡有关。
Objective To evaluate effect of Dexmedetomidine on inflammatory status in lung tissues of patients undergoing pulmonary lobectomy.Methods From November 2018 to November 2019,438 ASA I or II patients aged 30-70 years undergoing thoracoscopic lobotomy in the Affiliated Hospital of Qingdao University and Qingdao Municipal Hospital were enrolled in the study.Patients were randomly divided into 2 groups(n=219 each):patients in study group were given Dexmedetomidin 1.0μg/kg intravenously 10 min before anesthesia induction,then intravenously infused with Dexmedetomidin 0.3μg/kg until 30 min before the end of operation,while the equal volume of normal saline was given to patients in control group.Lung tissue samples were obtained during surgery,the expression of GSDMD,NLRP3,ASC and Caspase-1 in lung tissue was determined by Western blot,wet/dry lung weight ratio was measured and pathologic changes were observed.The arierial blood samples were collected for blood gas analysis,and the oxygenation index was calculated Immediately after onset of one lung ventilation(T1),at 15(T2),30(T3)and 60(T4)min of one-lung ventilation,and at 1 h after restoration of two-lung ventilation(T5).The postoperative complications and length of postoperative hospital stay were recorded.Results Compared with control group,the expression of GSDMD,NLRP3,ASC and Caspase-1 was significantly downregulated,the oxygenation index at T1~T5 were significantly increased(P<0.05),the pathologic score,the wet/dry lung weight ratio and incidence of postoperative pneumonia and atelectasis were significantly decreased(P<0.05),and the length of postoperative hospital stay was significantly shortened in study group(all P<0.05).Conclusion Dexmedetomidine can improve the inflammatory response of lung tissues in patients with lobotomy,thereby reducing acute lung injury,which may be related to the inhibition of pyroptosis in alveolar macrophages.
作者
辛苗
张春光
于京福
代汭
万效梅
王燕
王晓
XIN Miao;ZHANG Chunguang;YU Jingfu;DAI Rui;WAN Xiaomei;WANG Yan;WANG Xiao(Department of Anesthesiology,Qingdao Municipal Hospital,Qingdao 266071,China)
出处
《浙江医学》
CAS
2020年第21期2278-2282,2295,共6页
Zhejiang Medical Journal
