CAJ | 학술논문

目的探讨远隔缺血预处理联合右美托咪定对开胸手术患者单肺通气时肺损伤的影响.方法择期行开胸食管癌根治术患者30例,ASA分级Ⅰ或Ⅱ级,年龄45 ～ 70岁,体重50～ 70kg,采用随机数字表法分为2组(n=15):对照组(C组)和远隔缺血预处理联合右美托咪定组(ORD组).ORD组于气管插管完成后10 min,阻断下肢血流5 min,恢复灌注5 min,重复3次,进行缺血预处理,同时先静脉输注负荷量右美托咪定1.0 μg/kg 15 min,然后以0.5μg·kg-1 ·h-1的速率静脉输注至术毕.于单肺通气即刻、30 min、1、和2 h(T1-4)时,采集桡动脉血样,进行血气分析,计算氧合指数和呼吸指数,采用酶联免疫吸附法测定血浆TNF-α、IL-1β和IL-10的浓度.于T1和T34时,收集呼出气冷凝液,测定pH值.结果与C组比较,ORD组T2-4时氧合指数升高,呼吸指数降低,T3-4时血浆TNF-α和IL-1β的浓度降低,呼出气冷凝液pH值升高,T4时血浆IL-10浓度升高(P＜0.05).结论远隔缺血预处理联合右美托咪定可抑制开胸手术患者单肺通气时的炎性反应,减轻气道酸化,从而减轻肺损伤.
목적 탐토원격결혈예처리연합우미탁미정대개흉수술환자단폐통기시폐손상적영향.방법 택기행개흉식관암근치술환자30례,ASA분급Ⅰ혹Ⅱ급,년령45 ～ 70세,체중50～ 70kg,채용수궤수자표법분위2조(n=15):대조조(C조)화원격결혈예처리연합우미탁미정조(ORD조).ORD조우기관삽관완성후10 min,조단하지혈류5 min,회복관주5 min,중복3차,진행결혈예처리,동시선정맥수주부하량우미탁미정1.0 μg/kg 15 min,연후이0.5μg·kg-1 ·h-1적속솔정맥수주지술필.우단폐통기즉각、30 min、1、화2 h(T1-4)시,채집뇨동맥혈양,진행혈기분석,계산양합지수화호흡지수,채용매련면역흡부법측정혈장TNF-α、IL-1β화IL-10적농도.우T1화T34시,수집호출기냉응액,측정pH치.결과 여C조비교,ORD조T2-4시양합지수승고,호흡지수강저,T3-4시혈장TNF-α화IL-1β적농도강저,호출기냉응액pH치승고,T4시혈장IL-10농도승고(P＜0.05).결론 원격결혈예처리연합우미탁미정가억제개흉수술환자단폐통기시적염성반응,감경기도산화,종이감경폐손상.
Objective To investiga~ the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on the lung injury during one-lung ventilation (OLV) in the patients undergoing thoracic surgery.Methods Thirty ASA physical status Ⅰ or Ⅱ patients,aged 45-70 yr,weighing 51-69 kg,scheduled for elective radical operation for esophageal cancer,were randomly divided into 2 groups (n =15 each) using a random number table:control group (group C) and RIPC combined with dexmedetomidine group (group ORD).In ORD group,at 10 min after endotracheal intubation,RIPC was induced by 3 cycles of 5 min lower extremity ischemia followed by 5 min reperfusion,and at the same time a loading dose of dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min and then dexmedetomidine was infused at a rate of 0.5 μg· kg-1 · h-1 until the end of operation.At 0,30 min,1 h and 2 h of OLV (T1-4),blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β) and IL-10.Oxygenation index and respiratory index were calculated.Exhaled breath condensate was collected at T1,T3 and T4,and the pH value was measured.Results Compared with group C,oxygenation index was significantly increased,and respiratory index was decreased at T2-4,the plasma concentrations of TNF-α and IL-1β were decreased,and the pH value of exhaled breath condensate was increased at T3-4,and the plasma concentration of IL-10 was increased at T4 in group ORD.Conclusion RIPC combined with dexmedetomidine can inhibit inflammatory responses and reduce airway acidification,thus attenuating the lung injury during OLV in the patients undergoing thoracic surgery.