摘要
目的评价右美托咪定对胸腔镜肺叶切除术中单肺通气相关肺损伤时转化生长因子(TGF)-β/果蝇MAD类似基因(Smad)信号通路的影响。方法选取2018年6月至2019年6月择期全麻下拟行胸腔镜下肺叶切除术患者886例,男444例,女442例,年龄40~65岁,BMI 20~24 kg/m^2,ASAⅠ或Ⅱ级。采用随机数字表法分为两组:右美托咪定组(D组)和对照组(C组)。每组443例。D组于麻醉诱导前10 min以1.0μg/kg静脉输注右美托咪定负荷剂量,随后以0.3μg·kg^-1·h^-1速率输注至术毕前30 min,C组静脉输注等容量的生理盐水。于单肺通气即刻(T 0)、单肺通气15 min(T 1)、30 min(T 2)、60 min(T 3)、双肺通气后1 h(T 4)时采集动脉和静脉血2 ml,行血气分析并计算氧合指数(OI)和肺内分流率(Qs/Qt)。HE染色观察肺组织,计算肺湿干重(W/D)比值和肺病理学损伤评分。采用Western blot法检测肺组织TGF-β1、Smad2、Smad3、IL-6和TNF-α。记录术后48 h内肺炎、肺不张和呼吸衰竭的发生情况,记录术后住院时间。结果与C组比较,D组T 1-T 4时OI明显升高,Qs/Qt明显降低(P<0.05),W/D比值明显降低,肺病理学损伤评分明显降低(P<0.05),肺组织TGF-β1、Smad2、Smad3、IL-6和TNF-α明显降低(P<0.05),术后肺炎、肺不张并发症的发生率明显降低(P<0.05),术后住院时间明显缩短(P<0.05)。结论右美托咪定可降低胸腔镜肺叶切除术患者肺组织TGF-β1、Smad2、Smad3、IL-6和TNF-α,从而减轻急性肺损伤。
Objective To evaluate the influence of dexmedetomidine on transforming growth factor(TGF)-β1/Smad signaling pathways in patients with lung injury associated with one lung ventilation during thoracoscopic surgery.Methods A total of 886 undergoing pulmonary lobectomy,444 males and 442 females,aged 40-65 years,BMI 20-24 kg/m^2,falling into ASA physical statusⅠ-Ⅱ.They were randomly divided into two groups using random number table method:dexmedetomidine group(group D)and control group(group C),443 for each group.In group D,loading dose dexmedetomidine was injected intravenously in 10 min before anesthesia induction with 1.0μg/kg,injection rate was adjusted in 0.3μg·kg^-1·h^-1 until 30 min before the end of operation.Equal volume of normal saline was given in group C.2 ml arterial and venous blood were collected at immediate one lung ventilation(T 0),15 min(T 1),30 min(T 1),60 min(T 3)of one-lung ventilation,and 1 h after recovery of two-lung ventilation(T 4),the oxygenation index(OI)and Qs/Qt were calculated by the blood gas analysis.Lung tissue was observed by HE staining.The ratio of wet and dry lung weight(W/D)and the lung physical injury score were calculated.Western blot method was used to detect TGF-β1,Smad2,Smad3,IL-6,and TNF-αin lung tissue.The incidence of pneumonia,atelectasis and respiratory failure within 48 h after operation were recorded,and the postoperative hospitalization was recorded as well.Results Compared with group C,in group D,OI were significantly increased,Qs/Qt were significantly decreased at T 1-T 4(P<0.05),and the expression of TGF-β1,Smad2,Smad3,IL-6,and TNF-αwere significantly down-regulated(P<0.05),the pathologic score were significantly decreased(P<0.05),the ratio of wet/dry lung weight,the incidence of postoperative pneumonia and atelectasis were significantly decreased(P<0.05),and the postoperative hospital stay was significantly shortened in group D(P<0.05).Conclusion Dexmedetomidine can reduce the expression of TGF-β1,Smad2,Smad3,IL-6,and TNF-αin lung tissue of patients undergoing thoracoscopic loggectomy,so as to reduce acute lung injury.
作者
王磊
闻庆平
王秀丽
冯伟
王兰
丁彦玲
WANG Lei;WEN Qingping;WANG Xiuli;FENG Wei;WANG Lan;DING Yanling(Department of Anesthesiology,Baoding First Central Hospital,Baoding 071000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第11期1045-1049,共5页
Journal of Clinical Anesthesiology
基金
保定市科技计划项目(1941ZF036)。
