摘要
目的探讨右美托咪啶(Dex)对行食管癌根治术患者围术期肺内分流率(Qs/Qt)、炎性因子和Claudin-4的影响。方法选取山西医科大学第二医院2018年3月至8月择期拟在全身麻醉下行胸腹腔镜联合食管癌根治术患者60例,按照随机数字表法分成Dex组(观察组)和0.9%NaCl注射液组(对照组),两组采用相同的麻醉方式。观察组于麻醉诱导前经静脉泵注Dex,先以1.0μg/kg的负荷剂量(10 min输注完毕),而后以0.4μg·kg-1·h-1速率输注至手术结束前30 min;对照组输注相同量的0.9%NaCl注射液。两组分别在双肺通气后15 min(T0)、单肺通气30 min(T1)、单肺通气1 h(T2)、恢复双肺通气30 min(T3)4个时间点取桡动脉血、锁骨下静脉血行血气分析,计算Qs/Qt;采集锁骨下静脉血,用酶联免疫吸附法测定血清中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、Claudin-4水平。结果T0、T1、T2、T3时,对照组Qs/Qt分别为(13.6±3.6)%、(36.1±2.9)%、(31.8±2.4)%、(15.3±3.2)%,差异有统计学意义(F=397.273,P<0.01),观察组分别为(12.5±1.8)%、(27.4±3.0)%、(27.7±4.2)%、(13.9±3.4)%,差异有统计学意义(F=205.124,P<0.01),观察组Qs/Qt在T1、T2时低于对照组(t值分别为178.011、23.791,均P<0.01);对照组TNF-α浓度分别为(12.4±2.4)pg/ml、(20.5±3.0)pg/ml、(24.8±4.1)pg/ml、(34.3±8.0)pg/ml,差异有统计学意义(F=109.749,P<0.01),观察组分别为(11.4±3.0)pg/ml、(17.6±2.8)pg/ml、(17.4±3.1)pg/ml、(26.2±5.0)pg/ml,差异有统计学意义(F=87.653,P<0.01),观察组在T1、T2、T3时TNF-α浓度均低于对照组(t值分别为10.471、44.730、24.132,均P<0.05);对照组IL-6浓度分别为(18.4±4.0)pg/ml、(28.5±5.4)pg/ml、(40.1±6.0)pg/ml、(43.1±6.0)pg/ml,差异有统计学意义(F=200.151,P<0.01),观察组分别为(17.7±4.8)pg/ml、(21.9±3.9)pg/ml、(24.8±4.6)pg/ml、(24.0±3.8)pg/ml(F=14.655,P<0.01),观察组在T1、T2、T3时IL-6浓度低于对照组(t值分别为38.983、120.110、594.878,均P<0.01);对照组Claudin-4浓度分别为(5.9±0.8)ng/ml、(13.6±1.8)ng/ml、(14.7±4.5)ng/ml、(16.8±2.5)ng/ml,差异有统计学意义(F=89.332,P<0.01),观察组分别为(5.5±0.7)ng/ml、(16.8±1.8)ng/ml、(18.0±4.8)ng/ml、(21.2±4.4)ng/ml,差异有统计学意义(F=120.367,P<0.01),观察组在T1、T2、T3时Claudin-4浓度高于对照组(t值分别为54.619、7.112,18.766,均P<0.05)。结论Dex对肺内分流有一定的改善作用,且能抑制手术过程中的炎症反应和提升Claudin-4水平,对围术期的肺保护起到积极作用。
Objective To explore the effects of dexmedetomidine(Dex)on perioperative intrapulmonary shunt rate(Qs/Qt),inflammatory factors and Claudin-4 in patients with esophageal cancer undergoing radical operation.Methods Sixty patients with thoraco-laparoscopic combined esophageal cancer radical resection under general anesthesia were selected from the Second Hospital of Shanxi Medical University from March to August 2018.The patients were divided into Dex group(observation group)and 0.9%sodium chloride injection group(control group)according to the random number table method,and both groups were given the same anesthesia.In the observation group,Dex was injected intravenously before the anesthesia induction,the infusion was first performed at the loading dose of 1.0μg/kg(the infusion was completed in 10 minutes)and then the infusion was performed at the rate of 0.4μg·kg-1·h-1 until 30 minutes before the end of the operation.The control group was injected with the same dose of 0.9%sodium chloride injection.The radial artery blood and the subclavian venous blood was collected from the two groups at four time points of double lung ventilation for 15 minutes(T0),30 minutes(T1)and 1 hour(T2)after one-lung ventilation and 30 minutes(T3)after the restoration of bipulmonary ventilation.The blood gas was analyzed,and Qs/Qt was calculated.The blood samples from subclavian vein were collected,and the serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and Claudin-4 were measured by enzyme-linked immunosorbent assay.Results The Qs/Qt in the control group at T0,T1,T2 and T3 were(13.6±3.6)%,(36.1±2.9)%,(31.8±2.4)%,and(15.3±3.2)%,the difference was statistically significant,(F=397.273,P<0.01),and the Qs/Qt in the observation group were(12.5±1.8)%,(27.4±3.0)%,(27.7±4.2)%,and(13.9±3.4)%,the difference was statistically significant,(F=205.124,P<0.01);the Qs/Qt in the observation group at T1 and T2 were significantly lower than those in the control group(t values were 178.011 and 23.791,both P<0.05).The concentrations of TNF-αin the control group at T0,T1,T2 and T3 were(12.4±2.4)pg/ml,(20.5±3.0)pg/ml,(24.8±4.1)pg/ml,and(34.3±8.0)pg/ml,the difference was statistically significant,(F=109.749,P<0.01),and the concentrations of TNF-αin the observation group were(11.4±3.0)pg/ml,(17.6±2.8)pg/ml,(17.4±3.2)pg/ml,and(26.2±5.0)pg/ml,the difference was statistically significant,(F=87.653,P<0.01);the concentrations of TNF-αin the observation group at T1,T2 and T3 were significantly lower than those in the control group(t values were 10.471,44.730 and 24.132,all P<0.05).The concentrations of IL-6 in the control group at T0,T1,T2 and T3 were(18.4±4.0)pg/ml,(28.5±5.4)pg/ml,(40.1±6.0)pg/ml,and(43.1±6.0)pg/ml,the difference was statistically significant,(F=200.151,P<0.01),and the concentrations of IL-6 in the observation group were(17.7±4.8)pg/ml,(21.9±3.9)pg/ml,(24.8±4.6)pg/ml,and(24.0±3.8)pg/ml(F=14.655,P<0.01);the concentrations of IL-6 in the observation group at T1,T2 and T3 were significantly lower than those in the control group(t values were 38.983,120.110 and 594.878,all P<0.01).The concentrations of Claudin-4 in the control group at T0,T1,T2 and T3 were(5.9±0.8)ng/ml,(13.6±1.8)ng/ml,(14.7±4.5)ng/ml,and(16.8±2.5)ng/ml,the difference was statistically significant,(F=89.332,P<0.01),the concentrations of Claudin-4 in the observation group were(5.5±0.7)ng/ml,(16.8±1.8)ng/ml,(18.0±4.8)ng/ml,and(21.2±4.4)ng/ml,the difference was statistically significant,(F=120.367,P<0.01),the concentrations of Claudin-4 in the observation group at T1,T2 and T3 were significantly higher than those in the control group(t values were 54.619,7.112 and 18.766,all P<0.05).Conclusion Dex can improve the intrapulmonary shunt to some extent,inhibit the inflammatory response during the operation,and increase the level of Claudin-4,which plays an active role in perioperative lung protection.
作者
刘伟
高东艳
张利
Liu Wei;Gao Dongyan;Zhang Li(School of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《肿瘤研究与临床》
CAS
2020年第10期680-684,共5页
Cancer Research and Clinic
