陆海霞 李卫卫 周冬喜

【摘要】 目的：探讨右美托咪定复合帕瑞昔布钠对胸腔镜肺癌根治术单肺通气患者炎症因子水平及肺氧合的影响。方法：选取2021年1月—2023年1月海安市中医院收治的胸腔镜肺癌根治术单肺通气患者192例，采用随机数字表法分为三组，其中右美托咪定组（n=58）于麻醉诱导前20 min静脉滴注1 μg/kg右美托咪定，之后以0.6 μg/（kg·h）维持剂量输注至关胸，帕瑞昔布钠组（n=58）于麻醉诱导前20 min静脉滴注帕瑞昔布钠40 mg，复合组（n=76）给予右美托咪定复合帕瑞昔布钠静脉滴注。比较三组不同时间点炎症因子、肺氧合指标水平及疼痛程度，并记录三组不良反应发生情况。结果：单肺通气30 min（T1）、术毕（T2），三组血清C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）水平均较麻醉诱导前（T0）升高，差异均有统计学意义（P<0.05），但复合组T1、T2上述各项指标均低于右美托咪定组和帕瑞昔布钠组，差异均有统计学意义（P<0.05）；T1、T2，右美托咪定组和帕瑞昔布钠组上述各项指标比较，差异均无统计学意义（P>0.05）。T1、T2，三组动脉血氧分压（PaO2）、氧合指数（OI）水平均较T0降低，二氧化碳分压（PaCO2）水平均较T0升高，差异均有统计学意义（P<0.05），但复合组T1、T2的PaO2、OI均高于右美托咪定组和帕瑞昔布钠组，PaCO2水平均低于右美托咪定组和帕瑞昔布钠组，差异均有统计学意义（P<0.05）；T1、T2，右美托咪定组和帕瑞昔布钠组上述各项指标比较，差异均无统计学意义（P>0.05）。术后2、6、24 h，复合组VAS评分均低于右美托咪定组和帕瑞昔布钠组，差异均有统计学意义（P<0.05）；右美托咪定组和帕瑞昔布钠组各时间点VAS评分比较，差异均无统计学意义（P>0.05）。三组不良反应发生率比较，差异无统计学意义（P>0.05）。结论：右美托咪定复合帕瑞昔布钠可减轻胸腔镜肺癌根治术单肺通气患者炎症因子水平及术后疼痛程度，对患者肺氧合功能影响小。

【关键词】 胸腔镜肺癌根治术 单肺通气 右美托咪定 帕瑞昔布钠 炎症因子 肺氧合

Effects of Dexmedetomidine Combined with Parecoxib Sodium on Levels of Inflammatory Factors and Pulmonary Oxygenation in Patients with Single Lung Ventilation after Thoracoscopic Radical Resection of Lung Cancer/LU Haixia， LI Weiwei， ZHOU Dongxi. //Medical Innovation of China， 2024， 21（15）： 0-023

[Abstract] Objective： To investigate the effects of Dexmedetomidine combined with Parecoxib Sodium on the levels of inflammatory factors and pulmonary oxygenation in patients with single lung ventilation after thoracoscopic radical resection of lung cancer. Method： A total of 192 patients with single lung ventilation who underwent thoracoscopic radical resection for lung cancer treated in Haian Hospital of Traditional Chinese Medicine from January 2021 to January 2023 were selected and divided into three groups by random number table method. Dexmedetomidine group （n=58） was given 1 μg/kg Dexmedetomidine intravenically 20 min before anesthesia induction， after that， a maintenance dose of 0.6 μg/（kg·h） was administered to the chest. The Parecoxib Sodium group （n=58） was given 40 mg of Parecoxib Sodium intravenously 20 minutes before induction of anesthesia， and the compound group （n=76） was given Dexmedetomidine combined with Parecoxib Sodium intravenously. The levels of inflammatory factors， pulmonary oxygenation index and pain degree of the three groups were compared at different time points， and the occurrence of adverse reactions in the three groups were recorded. Result： After 30 min of single lung ventilation （T1） and after surgery （T2）， the levels of serum CRP， TNF-α and IL-1β in three groups were higher than those before anesthesia induction （T0）， the differences were statistically significant （P<0.05）， however， the above indexes of T1 and T2 in the compound group were lower than those in Dexmedetomidine group and Parecoxib Sodium group， the differences were statistically significant （P<0.05）， at T1 and T2， there were no significant differences in the above indexes between the Dexmedetomidine group and the Parecoxib Sodium group （P>0.05）. At T1 and T2， PaO2 and OI levels of the three groups were decreased compared with T0， and PaCO2 levels were increased compared with T0， the differences were statistically significant （P<0.05）; however， PaO2 and OI at T1 and T2 of compound group were higher than those in Dexmedetomidine group and Parecoxib Sodium group， and PaCO2 levels were lower than those in Dexmedetomidine group and Parecoxib Sodium group， the differences were statistically significant （P<0.05）; at T1 and T2， there were no significant differences in the above indexes between Dexmedetomidine group and Parecoxib Sodium group （P>0.05）. At 2， 6 and 24 h after surgery， VAS scores in the compound group were lower than those in Dexmedetomidine group and Parecoxib Sodium group， the differences were statistically significant （P<0.05）; there were no significant differences in VAS scores between Dexmedetomidine group and Parecoxib Sodium group at each time point （P>0.05）. There was no significant difference in the incidence of adverse reactions among the three groups （P>0.05）. Conclusion： Dexmedetomidine combined with Parecoxib Sodium can reduce the levels of inflammatory factors and postoperative pain in patients with single lung ventilation after thoracoscopic radical lung cancer surgery， the impact of oxygenation function is minimal.

[Key words] Thoracoscopic radical resection of lung cancer Single lung ventilation Dexmedetomidine Parecoxib Sodium Inflammatory factors Pulmonary oxygenation

First-author's address： Department of Anesthesiology， Haian Hospital of Traditional Chinese Medicine， Haian 226600， China

doi：10.3969/j.issn.1674-4985.2024.15.005

胸腔镜肺癌根治术是目前临床治疗早期肺癌有效手段之一，其中单肺通气是其术中常用特殊通气技术，能有效清除气道内分泌物，且具有避免癌灶转移和预防交叉感染的作用[1]。但单……