摘要目的 探讨右美托咪定对单肺通气(OLV)患者肺内分流以及炎性反应的影响.方法 选择56例择期行食管癌根治术患者,按随机数字表法分为右美托咪定组和对照组,每组28例.分别于开胸前(T0)、OLV后45 min(T1)、OLV后90 min(T2)、术后6 h(T3)以及术后24 h(T)检测血清白细胞介素(IL)-6、IL-8和肿瘤坏死因子α(TNF-α)浓度并计算肺内分流率(Qs/Qt).结果 与T0时比较,T1～T4时两组患者血清TNF-α、IL-6、IL-8浓度显著升高[右美托咪定组:(30.4±4.7)、(51.6±7.8)、(81.6±7.6)、(127.2±16.8)ng/L比(19.7±3.8)ng/L;(17.9±4.4)、(37.1±9.6)、(89.6±12.9)、(78.9±13.1)ng/L比(15.0±2.9)ng/L;(14.9±2.2)、(19.8±3.3)、(36.2±4.0)、(35.8±6.5)ng/L比(7.6±1.4)ng/L;对照组:(33.6±3.9)、(79.8±6.3)、(101.5±10.2)、(145.3±17.3)ng/L比(18.2±3.4)ng/L;(21.6±5.3)、(46.9±10.2)、(112.5±13.6)、(106.2±15.6)ng/L比(15.3±2.8)ng/L;(16.1±2.8)、(26.3±4.7)、(47.6±5.1)、(40.2±6.2)ng/L比(8.3±2.0)ng/L],差异有统计学意义(P＜0.01).T2～T4时两组患者血清TNF-α、IL-6、IL-8浓度比较差异亦有统计学意义(P＜0.05).但是,两组间Qs/Qt比较差异无统计学意义(P＞0.05).结论 围手术期持续输注右美托咪定在一定程度上能减轻OLV时炎性反应,但对肺内分流无明显影响.

abstracts[Objective]To explore the effects of dexmedetomidine on intrapulmonary shunt and inflammatory response in patients with one lung ventilation(OLV).[Methods] Fifty-six patients scheduled for radical resection of esophageal cancer were divided by random digits table method into dexmedetomidine group and control group with 28 cases each.Serum levels of interleukin(IL)-6,IL-8,tumor necrosis factor alpha(TNF- α)before openiαg the chest(To),at 30 min(T1)and 90 min(T2)after OLV,at 6 h(T3)and 24h(T4)after operation were detected and the intrapulmonary shunt fraction(Qs/Qt)was calculated.[Results]Compared with T0,serum levels ofTNF- α,IL-6 and IL-8 increased in both groups at T1-T4[dexmedetomidine group:(30.4 ± 4.7),(51.6 ± 7.8),(81.6 ± 7.6),(127.2 ± 16.8)ng/L vs.(19.7 ± 3.8)ng/L;(17.9 ± 4.4),(37.1 ± 9.6),(89.6 ± 12.9),(78.9 ± 13.1)ng/L vs.(15.0 ± 2.9)ng/L;(14.9 ± 2.2),(19.8 ± 3.3),(36.2 ±4.0),(35.8 ± 6.5)ng/L vs.(7.6 ± 1.4)ng/L;control group:(33.6 ±3.9),(79.8 ± 6.3),(101.5 ± 10.2),(145.3 ± 17.3)ng/L vs.(18.2 ±3.4)ng/L;(21.6 ±5.3),(46.9 ± 10.2),(112.5 ± 13.6),(106.2 ± 15.6)ng/L vs.(15.3 ±2.8)ng/L;(16.1 ±2.8),(26.3 ±4.7),(47.6 ±5.1),(40.2 ±6.2)ng/L vs.(8.3 ±2.0)ng/L],which had significant differences(P ＜ 0.01).There were statistical significance in the levels of TNF- α,IL-6 and IL-8 at T2-T4 between two groups(P ＜ 0.05).However,there was no statistical difference in Qs/Qt between two groups(P ＞ 0.05).[Conclusions] Perioperative continuous infusion of dexmedetomidine can reduce the inflammatory responses to a certain extent during OLV.But it has no obvious effects on intrapulmonary shunt.