盐酸右美托咪定对单肺通气患者术中血TNFα和IL6影响.pdf

间断静脉注射舒芬太尼0．2．0．4¨g／kg维持麻醉，以维持大脑双频指数 (BIS)值在40．60，根据血流动力学指标及BIS值调整药物用量。分 别于单肺通气前(T。)、单肺通气l小时(T0、单肺通气结束时(T2)采集 肘静脉血检测血清TNF．0【、IL．6浓度和采集动脉血监测pH、Pa02、 PaC02，同时记录各时点的(有创)MAP、HR、Sp02、PETC02、RR、 Ppeak和BIS值。并记录术中阿托品和多巴胺的使用情况。术后第1、2、 3天随访患者，记录当日最高体温(T)、HR、RR和白细胞计数或未 成熟中性粒细胞数。30例患者完成试验，D组】8例和C组12例。结果： 1．两组患者年龄、性别、体重、ASA分级、开胸部位及麻醉前相关 指标(Hb、MAP、HR、RR、Sp02、BIS)组间比较差异均无统计学 意义(尸0．05)。2．两组患者MAP、HR、Sp02、PETC02、RR、Ppeak 和BIS值在To、T1、T2时间点组间比较差异均无统计学意义(PO．05)。 3．两组患者动脉l血_pH、Pa02、PaC02在To、Tl、T2时间点组间比较差 异均无统计学意义(扮0．05)。4．两组患者术中各个时间点血浆TNF．O【 矛[IIL．6浓度的比较：组内比较：两组患者术中血浆TNF．a年IlIL．6浓度 在T-时间点与To比较、T2时间点与To比较及在T2时间点与T1比较差异 均有统计学意义(P0．05)；组间比较：在To时间点：两组患者术中 血浆TNF．a和IL．6浓度组间比较差异均无统计学意义(扮0．05)，在TI、 T2时间点：两组患者术中血浆TNF．a和IL．6浓度组间比较差异均有统 计学意义(P0．05)。5．两组患者术后第l、2、3天SIRS的相关指标组 间比较差异均无统计学意义(尸0．05)。结论：盐酸右美托咪定能抑 制单肺通气患者术中血浆TNF．a和IL．6水平的升高，但对术后SIRS的 相关指标无影响。 关键词：右美托咪定；单肺通气；TNF．0【；IL．6；急性肺损伤；全身 炎症反应综合征； Effects of dexmedetomidine hydrochioride on blood TNF-a and IL-6 during operations in patients with one-lung ventilation Abstract：objective：The effects of dexmedetomidine hydrochloride on blood TNF-a and IL-6 during operations in patients with one—lung ventilation(OLV)were explored through giving 1．099／kg dexme— detomidine hydrochloride ten minutes prior to anesthesia induction， followed by the infusion rate of 0．3 rtg／kg／h to closing chest． Methods： This trial was a prospective，randomized，double-blind，controlled design． Thirty patients scheduled for radical surgery for esophageal carcinoma， the American Society of Anesthesiologists(ASA)classification grade I-II，aged 44 to 71，were enrolled in this study．By means of the random number table，they were divided into dexmedetomidine group (group D)and control group(group C)．The main operations of anesthesia were done by the same person．During the trial，double—blinding was executed，i．e．before anesthesia，a superior anesthesiologist who was not involved in the anesthesia and the statistical analysis prepared tWO pipes of dexmedetomidine hydrochloride and saline(both