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目的通过观察肺癌根治术患者单肺通气(OLV)时白细胞介素IL-6、IL-8及IL-10的变化,探讨OLV所致肺损伤的机制及右美托咪啶在防治急性肺损伤(ALI)中所起的作用。方法 ASAⅠ或Ⅱ级,择期肺癌根治术患者30例,采用随机数字表法,将患者随机分为右美托咪啶组(D组)和对照组(C组),每组15例。右美托咪啶组:麻醉诱导前静脉泵入剂量为0.05μg/(kg·min)的右美托咪啶,10min后以0.2~0.7μg/(kg·h)维持,输注速率根据心率、血压等变化及时调整;对照组:泵注生理盐水。于麻醉诱导给药前1 min(T1)、OLV 30 min(T2)、60 min(T3)、90 min(T4)、120 min(T5)和恢复双肺通气TLV30 min(T6)时,抽取桡动脉血5 ml,3000转/min,离心10 min,取血清-80℃冻存,采用酶联免疫法测定血清IL-6、IL-8、IL-10浓度。结果与T1比较,T2~T6时IL-6、IL-8、IL-10浓度明显升高(P<0.01);与C组比较,D组T2~T6时IL-6、IL-8浓度降低,IL-10浓度升高,差异有显著统计学意义(P<0.05)。结论右美托咪啶能降低IL-6、IL-8浓度,升高IL-10浓度,表明右美托咪啶对单肺通气所致的肺损伤有保护作用。
Objective To observe the changes of interleukin-6, interleukin-8 and interleukin-10 in patients with lung cancer undergoing single lung ventilation (OLV) and explore the mechanism of OLV-induced lung injury and the effect of dexmedetomidine on the prevention and treatment of acute lung injury (ALI) in the role. Methods Thirty ASA Ⅰ or Ⅱ patients undergoing elective radical resection of lung cancer were randomly divided into two groups (group D) and control group (group C), with 15 cases in each group. In the dexmedetomidine group, dexmedetomidine was injected into the vein at a dosage of 0.05 μg / (kg · min) before anesthesia induction and maintained at 0.2-0.7 μg / (kg · h) after 10 min. The infusion rate was determined according to the heart rate , Blood pressure and other changes in a timely manner; control group: pump saline. At the time of 1 min (T1), 30 min (T2), 60 min (T3), 90 min (T4), 120 min (T5) and TLV30 min (T6) Arterial blood 5 ml, 3000 rev / min, centrifuged 10 min, serum -80 ℃ frozen, serum IL-6, IL-8, IL-10 concentrations were measured by enzyme-linked immunosorbent assay. Results Compared with T1, the concentrations of IL-6, IL-8 and IL-10 at T2 ~ T6 were significantly increased (P <0.01). Compared with group C, the concentrations of IL-6 and IL- , IL-10 concentration increased, the difference was statistically significant (P <0.05). Conclusion Dexmedetomidine can reduce the concentrations of IL-6 and IL-8 and increase the concentration of IL-10, indicating that dexmedetomidine has a protective effect on lung injury induced by one-lung ventilation.