CAJ | 학술논문

目的：探讨盐酸右旋美托咪定对食管癌根治术患者围术期肺功能及炎症反应的影响。方法：选择择期行食管癌根治术的ASAⅠ～Ⅱ级患者60例，分为对照组（ C组）、D1组和D2组（每组20例）。3组患者均采用相同的麻醉方法。麻醉诱导后D1组和D2组分别以0．3和0．5μg/（ kg· h）静脉泵入盐酸右旋美托咪定，手术结束前30 min停止；C组不做处理。分别于麻醉诱导前（T0）、单肺通气前（T1）、单肺通气后（T2）、关胸（T3）、术后24 h（T4）测定动脉血压分压，并计算肺泡-动脉氧分压差和呼吸指数；于T1、T2、T3时计算肺有效顺应性；于T0、T3、T4时检测血浆肿瘤坏死因子-α（ TNF-α）和人肺表面活性特异蛋白D（ SP-D）。结果：与T0时比较，T1～T3时3组的动脉血氧分压、肺泡-动脉氧分压差均升高（P＜0．05）；与T1比较，T3时C组气道平台压、气道峰压均升高（P＜0．05）。与C组相比，D1组和D2组在T3时TNF-α和SP-D的含量降低，其中D2组降低幅度小于D1组（P＜0．05）。结论：盐酸右旋美托咪定能够抑制食管癌根治术患者围术期炎性反应，并改善肺功能。
목적：탐토염산우선미탁미정대식관암근치술환자위술기폐공능급염증반응적영향。방법：선택택기행식관암근치술적ASAⅠ～Ⅱ급환자60례，분위대조조（ C조）、D1조화D2조（매조20례）。3조환자균채용상동적마취방법。마취유도후D1조화D2조분별이0．3화0．5μg/（ kg· h）정맥빙입염산우선미탁미정，수술결속전30 min정지；C조불주처리。분별우마취유도전（T0）、단폐통기전（T1）、단폐통기후（T2）、관흉（T3）、술후24 h（T4）측정동맥혈압분압，병계산폐포-동맥양분압차화호흡지수；우T1、T2、T3시계산폐유효순응성；우T0、T3、T4시검측혈장종류배사인자-α（ TNF-α）화인폐표면활성특이단백D（ SP-D）。결과：여T0시비교，T1～T3시3조적동맥혈양분압、폐포-동맥양분압차균승고（P＜0．05）；여T1비교，T3시C조기도평태압、기도봉압균승고（P＜0．05）。여C조상비，D1조화D2조재T3시TNF-α화SP-D적함량강저，기중D2조강저폭도소우D1조（P＜0．05）。결론：염산우선미탁미정능구억제식관암근치술환자위술기염성반응，병개선폐공능。
Aim:To investigate the effects of dexmedetomidine on pulmonary function and inflammatory response dur-ing perioperative period in the patients undergoing radical esophagectomy .Methods:Sixty ASAⅠor Ⅱpatients scheduled for radical esophagectomy were randomly divided into 3 groups ( 20 in each group ): control group ( group C ) , low dose dexmedetomidine group(group D1) and high dose dexmedetomidine group (group D2).The same standard anesthesia proto-col was used for induction and maintainence in all 3 groups.After induction, dexmedetomidine was infused at rate of 0.3μg/(kg· h) (group D1) and 0.5 μg/(kg· h) (group D2) until 30 min before the end of operation.Group C received the equal volume of normal saline .Arterial blood samples were collected for blood gas analysis before induction of anesthe-sia(T0),before OLV(T1),at the end of OLV(T2),when the chest was closed(T3)and at 24 h after operation(T4).p(A-a)O2 and respiratory index (RI) were calculated.Plasma TNF-αand SP-D were measured at T0, T3 and T4.Dynamic lung compliance(Cd) was calculated at T1,T2 and T3.Results: paO2,p(A-a) O2 at T1,T2, T3 and plasma TNF-α, SP-D concentrations at T3 were significantly increased as compared with the baseline values at T 0 in all 3 groups.The airway plat-form pressure and peak pressure was significantly raised at T 3 than T1 in all 3 groups.Plasma TNF-αand SP-D concentra-tions at T3 decreased in group D1 and D2 than those in group C, and the changes in group D2 was lower than those in group D1 .Conclusion:Dexmedetomidine can improve the lung function and prohibit inflammatory response of patients undergo -ing radical esophagectomy .