论文部分内容阅读
目的：观察右美托咪啶（dexmedetomidine，DEX）对胸腹腔镜联合食管癌根治术患者单肺通气时中性粒细胞（PMN）核因子-κB（NF-κB）活性及血清中TNF-α、IL-10和IL-8水平的影响。方法：择期行电子胸腹腔镜联合食管癌根治术患者40例，ASA分级Ⅰ或Ⅱ级，体重47~75 kg，年龄36~67岁，男女不限，采用随机数字表法分为两组：右美托咪啶组（D组，n=20）和对照组（C组，n=20）。麻醉诱导前，D组静脉泵注右美托咪啶1μg/kg（泵注时间为10 min），随后以0.5μg/（kg·h）的速率泵注至手术结束前30 min，C组采用D组同样的方法静脉泵注等容量生理盐水。于单肺通气前即刻（T0）、单肺通气30 min（T1）、单肺通气90 min（T2）、单肺通气结束后30 min（T3）、单肺通气结束后4 h（T4）和单肺通气结束后24 h（T5）时采集动脉血样5 mL，分离中性粒细胞和血清，应用ELISA法检测中性粒细胞NF-κB活性及血清中TNF-α、IL-8和IL-10浓度。同时抽取动脉血1 mL，行动脉血气分析，计算患者肺泡-动脉血氧分压差[P（A-a）O2]和呼吸指数（RI）。结果：D组和C组中性粒细胞NF-κB活性在T1后开始升高，T3达峰；D组中性粒细胞NF-κB活性在单肺通气开始后各时间点低于对照组（P<0.05）。两组血清TNF-α、IL-10和IL-8水平均在T2后开始升高（P<0.05），T3达高峰，但在T5依然高于术前水平；D组血清TNF-α和IL-8水平在T2、T3、T4、T5均低于C组（P<0.05），D组血清IL-10水平在T2后各时点均高于C组（P<0.05）。两组P（A-a）O2和RI均于单肺通气开始后升高，但D组较C低。结论：右美托咪啶可通过降低胸腹腔镜联合食管癌根治术患者单肺通气时PMN NF-κB活性进而降低促炎因子的表达，抑制单肺通气患者炎症反应，保护肺脏功能。“,”Objective:To observe the effects of Dexmedetomidine on NF-κB activity of polymorphonuclear neutrophils,TNF-α,IL-8 and IL-10 expression in one lung ventilation(OLV) patients.Method:Forty electronic thoracoscope esophagus cancer radical resection patients were divided randomly into two groups:the control group(C group,n=20) and Dexmedetomidine group(D group,n=20).5 milliliter radialartery blood was abstracted at the beginning of OLV(T0),30 min(T1),90 min(T2) after the beginning of OLV,30 min(T3),4 h(T4) and 24 h(T5) after one lung ventilation finished.NF-κB activity was measured in ELISA and expression of TNF-α,IL-10 and IL-8 were tested in ELISA.Alveolar-arterial blood oxygen difference[P(A-a)O2] and respiratory index(RI) were also recorded at the same time.Result:The value of NF-κB activity rised after T1,the peak value of NF-κB activity was got T3.NF-κB activity in D group was lower than that of C group at all time points after T0.Expression of TNF-α,IL-8 and IL-10 rised in two groups at T2,T3, T4 and T5.TNF-α and IL-8 expression in C group were higher than those in D group on T1,T2,T3,T4 and T5.But IL-10 expression in C group was lower than that in D group at the same time.The value of P(A-a)O2 and RI showed a progressive rise after T0.The value of P(A-a)O2 and RI in C group were higher than those in D group after T0.Conclusion:Dexmedetomidine can reduce the activity of NF-κB and then reduce the expression of TNF-α and IL-8.Dexmedetomidine can reduce inflammatory reaction during OLV and shows positive pulmonary protection.