Effects of lung protective ventilation strategy combined with dexmedetomidine on oxidative stress response and postoperative pulmonary complications in patients undergoing thoracic surgery
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摘要:
目的：观察肺保护性通气策略联合右美托咪定对胸腔镜下肺癌根治术患者氧化应激反应及术后肺部并发症的影响。方法：选择ASAⅠ~Ⅱ级择期行胸腔镜下右肺癌根治术的患者80例，随机分为传统通气模式组（C组）、肺保护性通气策略组（P组）、右美托咪定组（D组）、肺保护性通气策略联合右美托咪定组（P-D组），每组20例。各组于麻醉诱导前（T0）、单肺通气前即刻（T1）、单肺通气30 min（T2）、单肺通气1 h（T3）、单肺通气2 h（T4）、恢复双肺通气15 min（T5）行血气分析，并计算氧合指数（oxygenation index，OI）；于T0、T1、T3、T4、术后2 h（T6）、术后24 h （T7）测定血清丙二醛（malondialdehyde，MDA）、超氧化物歧化酶（superoxide dismutase，SOD）的含量；并记录各组术后肺部并发症的发生率。结果：与C组比较，D组患者于T5时间点OI显著升高（P < 0.05），P-D组患者OI于T1～T5均显著升高（P < 0.05或P < 0.01）；与P组比较，P-D组患者则于T1～T5 OI均显著升高（P < 0.05或 P < 0.01）；与C组比较，P组患者于T4、T6、T7，D组和P-D组患者于T3、T4、T6、T7升高MDA水平显著降低（P < 0.05或 P < 0.01），P组患者于T6、T7，D组患者于T4、T6、T7，P-D组患者于T3、T4、T6、T7 SOD水平显著升高（P < 0.05或 P < 0.01）；与P组比较，P-D组患者于T3、T4、T6、T7 MDA水平显著降低，SOD水平显著升高（P < 0.05或 P < 0.01）。结论：肺保护性通气策略联合右美托咪定可以进一步提高氧合，显著减轻机体氧化应激反应。
Abstract:
Objective：To observe the effects of lung protective ventilation strategy combined with dexmedetomidine on oxidative stress response，and postoperative pulmonary complications in patients with pulmonary carcinoma undergoing thoracoscopic radical resection. Methods：Eighty ASAⅠor Ⅱ patients scheduled for thoracoscopic lobectomy were randomly divided into 4 groups（n=20 each）：conventional ventilation group（group C），lung protective ventilation strategy group（group P），dexmedetomidine group（group D）and lung protective ventilation strategy combined with dexmedetomidine group（group P-D）. Arterial blood samples in all groups were collected at baseline（T0），at the time just before OLV（T1），at 30 min after OLV（T2），at 60 min after OLV（T3），at 120 min after OLV（T4）and 15 min after the restoration of TLV（T5）for blood gases analyse and oxygenation index was calculated. The concentration of serum MDA，SOD were measured at the time points of T0，T1，T3，T4，2 hours after operation（T6）and 24 hours after operation（T7）. The incidiences of postoperative pulmonary complications in all groups were recorded. Results：Compared with group C，OI at T5 in group D，at T1~T5 in group P-D was significantly increased（P < 0.05 or P < 0.01）. Compared with group P，OI at T1~T5 in group P-D was significantly increased（P < 0.05 or P < 0.01）. Compared with group C，the concentration of MDA at T4，T6，T7 in group P，at T3，T4，T6，T7 in group D and group P-D was significantly decreased（P < 0.05 or P < 0.01），while the level of SOD at T6，T7 in group P，at T4，T6，T7 in group D and at T3，T4，T6，T7 in group P-D respectively was significantly higher than that of in group C（P < 0.05 or P < 0.01）. Compared with group P，the concentration of MDA at T3，T4，T6，T7 in group P-D was significantly decreased，while the level of SOD at the same time points in group P-D was significantly increased（P < 0.05 or P < 0.01）. Conclusion：Lung protective ventilation strategy combined with dexmedetomidine can further increase oxygenation，attenuate oxidative stress response.
