摘要
目的探讨右美托咪啶对胸腔镜肺叶切除术老年肺癌患者肺损伤及CCAAT/增强子结合蛋白同源蛋白(CHOP)表达的影响。方法前瞻性研究。选取2018年10月至2019年3月郑州大学第二附属医院择期拟行辅助胸腔镜手术肺叶切除术的老年肺癌患者共120例,随机数字表法分为右美托咪啶组(D组,n=60)和对照组(C组,n=60)。比较两组患者术后清醒和自主呼吸恢复时间、苏醒期躁动发生情况。记录麻醉诱导前(T0)、气管插管后即刻(T1)、单侧肺通气即刻(T2)、单侧肺通气后1 h(T3)、双肺通气即刻(T4)、手术结束时(T5)平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)、氧分压(PaO2)、肺泡-动脉氧分压的差值[P(A-a)O2]、呼气末二氧化碳分压(PETCO2)和气道压力峰值(Ppeak)的情况。比较两组T0、T1、T2、T3、T4和T5时刻肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8和IL-10等炎症指标以及超氧化物歧化酶(SOD)和丙二醛(MDA)等氧化应激指标;检测肺组织中的肺泡损伤数比值(IQA)、凋亡指数(AI)、CHOP mRNA及蛋白表达。结果D组患者术后清醒和自主呼吸恢复时间均显著短于C组(均P<0.05);两组患者T1~T5时刻MAP、HR水平显著低于T0时刻。C组患者T3~T5时刻Ppeak水平均显著高于D组(均P<0.05)。D组患者T1~T5时刻PaO2均显著高于C组,P(A-a)O2水平均显著低于C组(均P<0.05)。D组患者T1~T5时IL-6、IL-8和MDA水平均显著低于C组,IL-10和SOD水平均显著高于C组(均P<0.05)。两组患者T4时刻IQA、AI及CHOP mRNA和蛋白表达水平均显著高于T2时刻(均P<0.05),且D组T4时刻IQA、AI及CHOP mRNA和蛋白表达水平显著低于C组(均P<0.05)。结论右美托咪啶能够减轻胸腔镜肺叶切除术老年肺癌患者肺损伤的程度,其机制可能与右美托咪啶抑制术中炎性因子的表达、改善氧化应激状态及降低CHOP介导的肺组织细胞凋亡等有关。
Objective To evaluate the effect of dexmedetomidine on lung injury and CCAAT/enhancer-binding protein homologous protein(CHOP)expression in elderly patients with lung cancer undergoing thoracoscopic lobectomy.Methods A total of 120 elderly patients with lung cancer who underwent elective thoracoscopic lobectomy were selected from the Second Affiliated Hospital of Zhengzhou University from October 2018 to March 2019.The random phenotype was divided into dexmedetomidine group(group D,n=60)and control group(group C,n=60).The elapsed time before postoperative awake and spontaneous breathing recovery and agitation occurrence were recorded.The mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SPO2),oxygen partial pressure(PaO2),alveolar-arterial oxygen partial pressure difference[P(A-a)O2],end-tidal carbon dioxide partial pressure(PETCO2),and airway pressure peak(Ppeak)were recorded before the anesthetic induction(T0),immediately after tracheal intubation(T1),immediately after unilateral pulmonary ventilation(T2),1 hour after unilateral pulmonary ventilation(T3),immediately after bilateral pulmonary ventilation(T4),and at the end of surgery(T5).The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-8,IL-10,super oxide dismutase(SOD)and malondialdehyde(MDA)were compared at the time of T0,T1,T2,T3,T4 and T5 in two groups.The ratios of alveolar damage(IQA),apoptotic index(AI),and the expression of CHOP mRNA and their protein in lung tissue were detected.Results The recovery time of conscious and spontaneous breathing in group D were significantly shorter than that in group C(P<0.05).The MAP and HR of the two groups at T1-T5 were significantly lower than those at T0(P<0.05).The levels of Ppeak in group C at T3-T5 was significantly higher than those in group D(P<0.05).The SpO2 values in the group D at T1-T5 were significantly higher than those in group C(P<0.05).The P(A-a)O2 values in the group D at T1-T5 was significantly lower than those in group C(P<0.05).The levels of IL-6,IL-8 and MDA in group D at T1-T5 were significantly lower than those in group C(P<0.05).The levels of IL-10 and SOD in group D at T1-T5 were significantly higher than those in group C(P<0.05).The values of IQA,AI,and the expression of CHOP mRNA and their protein in the two groups at T4 were significantly higher than those at T2(P<0.05).The values of IQA,AI,and the expression of CHOP mRNA and their protein in group D at T4 were significantly lower than those in group C(P<0.05).Conclusions Dexmedetomidine could attenuate the extent of lung injury in elderly patients with lung cancer undergoing thoracoscopic lobectomy.The pulmonary protective mechanism could be related to the inhibition of inflammatory factors in dexmedetomidine,improving oxidative stress and reducing Chop-mediated apoptosis of lung tissue by the protein.
作者
刘贵春
孙凯
付红光
董铁立
袁峰
Liu Guichun;Sun Kai;Fu Hongguang;Dong Tieli;Yuan Feng(Department of Anesthesiology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第1期37-41,共5页
National Medical Journal of China
基金
河南省医学科技攻关项目(2018020156)。
关键词
右美托咪啶
老年人
肺肿瘤
胸腔镜
肺通气
肺损伤
Dexmedetomidine
Aged
Lung neoplasms
Thoracoscopes
Pulmonary ventilation
Lung injury
