周海燕 潘建红 陈念平 沈琴 宋铖

[摘要] 目的 探讨右美托咪定对胸腔镜下肺叶切除患者氧化应激和炎症反应的影响。 方法 选择2018年8月至2020年8月在本院接受胸腔镜下肺叶切除手术患者60例，采用随机数字表法分为观察组和对照组，观察组患者诱导前10 min通过静脉输注泵持续输注右美托咪定0.5 μg/kg、诱导结束后再以0.5 μg/（kg·h）維持泵注;对照组给予等容量生理盐水。记录患者麻醉诱导前（T1）、诱导插管后（T2）、手术60 min时（T3）、手术结束时（T4）以及拔管后（T5）各时间点的血流动力学指标：心率（HR）、平均动脉压（MAP）和血氧饱和度（SpO2）;检测麻醉前、手术中、手术结束时、术后12 h和术后24 h的血清SOD、MDA、C-反应蛋白（CRP）、TNF-α、IL-1β和IL-6水平。 结果 两组T1时间点各观察指标无明显差异，观察组T2、T3、T4时间点MAP及HR明显低于对照组（P<0.05）;观察组手术中、手术结束时、术后12 h和术后24 h各个时间点较对照组各个时间血清SOD明显升高，而MDA、C-反应蛋白、TNF-α、IL-1β和IL-6均低于对照组（P<0.05）。 结论 肺切除患者麻醉过程中，复合使用右美托咪定可以保持患者围手术期血流动力学稳定，并可以显著减轻患者氧化应激和炎症反应。

[关键词] 右美托咪定;肺叶切除;氧化应激;炎症反应

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2021）36-0124-04

Effects of dexmedetomidine on perioperative oxidative stress and inflammatory response in patients undergoing thoracoscopic pulmonary lobotomy

ZHOU Haiyan   PAN Jianhong   CHEN Nianping&nbsp;  SHEN Qin   SONG Cheng

Department of Anesthesiology， Affiliated Hospital of Shaoxing University of Arts and Sciences， Shaoxing   312000， China

[Abstract] Objective To explore the effects of dexmedetomidine on oxidative stress and inflammatory response in patients undergoing thoracoscopic pulmonary lobotomy. Methods A total of 60 patients receiving thoracoscopic pulmonary lobotomy in our hospital from August 2018 to August 2020 were selected and divided into the observation group and the control group by the random number method. Patients in the observation group were given continuous infusion of dexmedetomidine by 0.5 μg/kg through intravenous infusion pump 10 minutes before anesthesia induction， and then maintained infusion at 0.5 μg/（kg·h） after anesthesia induction. The control group was given normal saline of equal volume. Hemodynamic indexes of patients before anesthesia induction （T1）， after anesthesia induction and intubation （T2）， 60 minutes after surgery started （T3）， at the end of surgery （T4） and after extubation （T5） were recorded： heart rate （HR）， mean arterial pressure （MAP）， oxygen saturation （SpO2）. The levels of SOD， MDA， C-reactive protein （CRP）， TNF-α， IL-1β and IL-6 in serum were measured before anesthesia， during surgery， at the end of surgery， 12 hours and 24 hours after surgery. Results There were no significant differences in the observation indexes between the two groups at T1. MAP and HR of the observation group at T2， T3 and T4 were significantly lower than those of the control group （P<0.05）. Compared with the control group， SOD in serum in the observation group increased significantly during surgery， at the end of surgery， 12 hours after surgery and 24 hours after surgery， while the levels of MDA， C-reactive protein， TNF-α， IL-1β and IL-6 in the observation group were lower than those in the control group at these time points （P<0.05）. Conclusion Combined administration of dexmedetomidine during anesthesia in patients undergoing pulmonary lobectomy can help them maintain perioperative hemodynamic stability and significantly reduces oxidative stress and inflammatory response.

[Key words] Dexmedetomidine; Pulmonary lobectomy; Oxidative stress; Inflammatory response

临床研究表明，围手术期过程中的外科操作、麻醉藥物以及患者本身疾病状态而诱发的机体氧化应激反应与炎症反应可以影响手术效果、患者预后以及不良反应发生率，减少手术过程的应激和炎症反应有利于提高手术效果和促进患者康复，减少并发症的发生[1-2]。肺切除患者由于手术创伤、疾病影响及机械通气导致的呼吸性相关肺损伤可进展为全身炎症反应综合征[3]。……