右美托咪定在全麻手术中对炎症及肺损伤保护作用的探讨.pdf

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1、中华医院感染学杂志2013年第23卷第1O期ChinJNosocomiolVo1．23No．102013·2343··论著·右美托咪定在全麻手术中对炎症及肺损伤保护作用的探讨邓若熹，张晟，张锦枝，吴新海(1．北京大学深圳医院麻醉科2．骨关节科，广东深圳518036)摘要：目的探讨右美托咪定在七氟烷吸入麻醉中对肺癌手术单肺通气(OLV)患者炎症状态及肺损伤的保护作用，为临床诊断治疗提供决策依据。方法将44例行肺癌根治术患者随机分为对照组与联合组，术中采用七氟烷吸入全身麻醉单肺机械通气，联合组联用右美托咪定；观察不同时间点两组患者血清中自介素(IL)

2、一1p、IL一10以及肿瘤坏死因子(TNF)一a水平变化；比较两组术中肺脏组织标本匀浆中丙二醛(MDA)、髓过氧化物酶(MPO)以及黄嘌呤氧化酶(XOD)水平。结果OLV后所有患者血清IL一117、IL-10以及TNF_a均呈显著升高趋势(P<0．05)，在60min及90rain，联合组血清IL一1口、TNF—a水平均显著低于对照组；在90min联合组血清IL-10水平显著高于对照组；联合组肺组织匀浆中MDA、MPO以及XOD水平均显著低于对照组(P

3、。关键词：右美托咪定；单肺通气；肺损伤中图分类号：R181．32文献标识码：A文章编号：1005—4529(2013)10—2343—03Dexmedetomidineinprotection0finflammationandlunginjuryduringgeneralanesthesiaDENGRUO—Xi，ZHANGSheng，ZHANGJin—zhi，WUXin—hai(PekingUniversityShenzhenHospital，Shenzhen，Guangdong518036，China)Abstract：OBJECTIVEToe

4、xploretheeffectsofdexmedetomidineonprotectionoflunginjuryandinflammationofthelungcancerpatientswithone-lungventilationundersevofluraneinhalationanesthesiaSOastoguidetheclinicaldiagnosisandtreatment．METHoDSAtotalof44patientswhoreceivedradicalsurgeriesweredividedintothecontrolg

5、roupandthecombinationgrouprandomly，allthepatientsweregiventreatmentof0LV，thecombinationgroupreceivedtreatmentofdexmedetomidine．TheserumlevelsofIL一1beta，IL一10andTNF-alphawereobservedandcompared；MDA，MPOandXODlevelsofsurgicallungtissuesamplehomogenateweretestedandcompared．RESULT

6、STheserumlevelsofI1beta，IL-10andTNF-alphaincreasedsignificantlyaftertheapplicationofOLVwiththeextensionoftime(P<0．05)；60min(T2)and90min(T3)after0LV，theserumlevelsofIL一1betaandTNF—alphaweresignificantlylowerinthecombinationgroupthaninthecontrolgroup；90minafterOLV，theserumlevel

7、ofIL-10wassignificantlyhigherinthecombinationgroupthaninthecontrolgroup，thelevelsofMDA，X0DandMPOinsurgicallungtissuesamplehomogenateweresignificantlylowerinthecombinationgroupthaninthecontrolgroup(P<0．05)．CONCLUSIONDexmedetomidineshowsprotectioneffectsoflungduringtreatmentof0

8、LV，mainlyviarestrainingextentofinflammatoryandredoxreactions．Keyword