摘要
目的观察右美托咪定对单肺通气(one-lung ventilation,OLV)患者肺组织核因子κB(nuclear factor-κB,NF-κB)表达及血浆肿瘤坏死因子α(tumor necrosis factor,TNF-α)和细胞间黏附分子1(intercellular adhesion molecule^(-1),ICAM^(-1))水平的影响,探讨右美托咪定对OLV患者肺保护作用的机制。方法择期行肺癌根治术患者40例,采用随机数字表法分为对照组和右美托咪定组各20例。麻醉诱导10min后右美托咪定组经静脉输注右美托咪定1μg/kg,随后以0.5μg·kg^(-1)·h^(-1)的速率输注至手术结束前30min;对照组采用同样的方法静脉输注等容量的生理盐水。于OLV前即刻(T_1)、OLV 60min(T_2)、恢复双肺通气后30min(T_3)、术后2h(T_4)和术后24h(T5)取桡动脉血,测定血气指标计算氧合指数(oxygenation index,OI)、呼吸指数(respiratory index,RI)及动脉肺泡氧分压比(PaO_2/PAO_2),测定血浆TNF-α和ICAM^(-1)浓度。于肺叶离体时在距肿瘤>5cm处取肺组织,测定NF-κB的表达。结果 2组OI和PaO_2/PAO_2在T_2~T_4时较T_1时降低,右美托咪定组在各时间点均高于对照组(P<0.05)。2组RI值在T_2~T_4时较T_1时升高,右美托咪定组在各时间点均低于对照组(P<0.05)。2组血浆TNF-α和ICAM^(-1)浓度呈升升降降趋势,右美托咪定组在T_2~T_4时均低于对照组(P<0.05)。右美托咪定组肺组织NF-κB表达较对照组升高(P<0.05)。结论给予1μg/kg的右美托咪定负荷量,随后以0.5μg·kg^(-1)·h^(-1)的速率持续输注,可以抑制肺组织NF-κB的激活,减轻OLV导致的全身炎症反应,改善患者的氧合功能,发挥肺保护作用。
Objective To observe the effects of dexmedetomidine on lung nuclear factor-κB（NF-κB）expression and the plasma tumor necrosis factor-α（TNF-α）and intercellular adhesion molecule-（-1）（ICAM^-1）levels in patients undergoing one lung ventilation（OLV）and to investigate the mechanism of lung protection.Methods Forty lung cancer patients scheduled for radical operation were randomly divided into 2groups（n=20in each group）by using a random number table：control group and dexmedetomidine group.In dexmedetomidine group,dexmedetomidine 1μg/kg was infused intraveineusly（iv）after 10 min anaesthesia induction,and then was infused at a rate of 0.5μg·kg^-1·h^-1 until 30 min ahead of the end of operation.In control group,the equal volume of normal saline was infused.Arterial blood samples were collected immediately before OLV（T1）,60 min after OLV（T2）,30 min after bilateral pulmonary inflating（T3）,2h after operation（T4）and 24 hafter operation（T5）to obtain arterial blood gas analysis data,oxygen index（OI）,respiratory index（RI）,PaO2/PAO2 and to determine levels of plasma TNF-αand ICAM^-1.Lung tissues were obtained more than 5cm away from tumor at the time of lobectomy of lungs in order to determine NF-κB expression.Results The values of OI and PaO2/PAO2 were decreased at T2-T4than that of at T1 in two groups.The values of OI and PaO2/PAO2 were increased in dexmedetomidine group compared to that in control group at T2-T4（P〈0.05）.The values of RI were increased at T2-T4than that of at T1 in two groups,and were decreased in dexmedetomidine group compared to that in control group at T2-T4（P〈0.05）.Plasma TNF-αand ICAM^-1levels showed ascending and descending trends,and were decreased in dexmedetomidine group compared to that in control group at T2- T4（P〈0.05）.The expression of NF-κB was increased in dexmedetomidine group compared to that in control group（P〈0.05）.Conclusion Dexmedetomidine with 1μg/kg loading dose and 0.5μg·kg^-1·h^-1continuing infusion dose during operation can inhibit activation of NF-κB and reduce OLV induced inflammatory response as well as improve oxygenation function and show its lung protection roles.
出处
《河北医科大学学报》
CAS
2016年第3期301-305,共5页
Journal of Hebei Medical University
基金
河北省医学科学研究重点课题(20150646)
