标题：负荷量右美托咪定联合乌司他丁在胸腔镜肺叶切除患者中的应用

      作者：庄莹莹，喻倩，和优娟    空军军医大学第二附属医院麻醉科，陕西 西安 710038

      卷次： 2020年31卷12期

      【摘要】 目的 探讨负荷量右美托咪定联合乌司他丁在胸腔镜肺叶切除患者中的临床应用效果。方法 选取2017年1月至2019年12月于空军军医大学第二附属医院行胸腔镜肺叶切除患者86例，按照随机数表法将患者分为观察组和对照组各43例，所有患者均给予全身复合麻醉，术中行单肺通气。对照组患者给予乌司他丁，观察组患者在对照组的基础上添加负荷量右美托咪定。比较两组患者气管插管5 min (T0)、单肺通气半小时(T1)、单肺通气1 h(T2)、单肺通气2 h (T3)、恢复双侧通气半小时(T4)的血浆白细胞介素-6 (IL-6)、血浆白细胞介素-10 (IL-10)水平，比较两组患者术后12 h、术后24 h、术后48 h、术后72 h呼吸功能用力肺活量(FVC)、1 s用力呼气容积(FEV1)水平以及拔管时间、治疗后镇静评分和躁动评分情况。结果 观察组患者T1、T2、T3、T4时刻 IL-6水平[(20.37±3.28) pg/mL、(24.72±4.71) pg/mL、(27.53±5.43) pg/mL、(25.71±5.18) pg/mL]明显低于对照组[(27.17±4.53) pg/mL、(38.47±5.62) pg/mL、(44.87±7.38) pg/mL、(40.27±6.56) pg/mL]，差异均有统计学意义(P<0.05)；观察组患者T1、T2、T3、T4时刻 IL-10水平[(21.72±4.51) pg/mL、(28.27±5.47) pg/mL、(33.25±6.36) pg/mL、(38.43±6.54) pg/mL]明显高于对照组[(19.24±3.42) pg/mL、(22.53±4.28) pg/mL、(26.43±5.34) pg/mL、(28.38±5.82) pg/mL]，差异均有统计学意义(P<0.05)；观察组患者术后12 h、术后24 h、术后48 h、术后72 h，呼吸功能FVC水平[(54.38±5.39)%、(57.58±6.34)%、(60.23±6.43)%、(63.45±8.49)%]、FEV1水平[(36.56±4.34)%、(43.43±5.39)%、(50.39±6.34)%、(57.25±7.17)%]明显高于对照组FVC水平[(43.34±4.43)%、(46.63±5.32)%、(50.39±5.83)%、(53.52±6.74)%]、FEV1水平[(28.38±2.53)%、(34.19±3.52)%、(38.72±4.61)%、(44.39±5.73)%]，差异均有统计学意义(P<0.05)；观察组患者的拔管时间为(16.64±4.59) min，明显长于对照组的(12.35±3.72) min，镇静评分为(3.75±0.83)分，明显高于对照组的(1.54±0.25)分，躁动评分为(1.26±0.12)分，明显低于对照组的(2.54±0.43)分，差异均有统计学意义(P<0.05)。结论 负荷量右美托咪定联合乌司他丁治疗胸腔镜肺叶切除术患者可改善患者炎症因子水平，对肺功能保护作用显著，值得临床推广应用。
      【关键词】 胸腔镜肺叶切除；负荷量右美托咪定；乌司他丁；肺功能；单肺通气
      【中图分类号】 R655 【文献标识码】 A 【文章编号】 1003—6350（2020）12—1497—04

Effect of dexmedetomidine combined with ulinastatin on patients undergoing thoracoscopic lobectomy.
ZHUANGYing-ying, YU Qian, HE You-juan. Department of Anesthesiology, the Second Affiliated Hospital of Air Force MilitaryMedical University, Xi'an 710038, Shaanxi, CHINA
【Abstract】 Objective To explore the effect of dexmedetomidine combined with ulinastatin on patients under-going thoracoscopic lobectomy, and to provide basis for clinical diagnosis. Methods From January 2017 to December2019, 86 patients with thoracoscopic lobectomy were selected from the Second Affiliated Hospital of Air Force MilitaryMedical University. According to random number table method, the patients were divided into the observation group andthe control group, with 43 patients in each group. All the patients were given general compound anesthesia. The patientsin the control group were additionally given one lung ventilation and ulinastatin, while the patients in the observationgroup were additionally added with dexmedetomidine on the basis of the control group. The levels of interleukin-6(IL-6) and plasma interleukin-10 (IL-10) on tracheal intubation for 5 min (T0), single lung ventilation for half an hour(T1), single lung ventilation for 1 hour (T2), single lung ventilation for 2 hours (T3), and recovery of bilateral ventilationfor half an hour (T4) in the two groups were compared. After 12 hours, 24 hours, 48 hours, and 72 hours of the opera-tion, the level of forced expiratory volume in one second (FEV1) and the time of extubation, sedation score and agitationscore after treatment were also compared. Results The levels of IL-6 at the time of TI, T2, T3, and T4 in the observa-tion group were (20.37 ± 3.28) pg/mL, (24.72 ± 4.71) pg/mL, (27.53 ± 5.43) pg/mL, (25.71 ± 5.18) pg/mL, respectively,which were significantly lower than corresponding (27.17 ± 4.53) pg/mL, (38.47 ± 5.62) pg/mL, (44.87 ± 7.38) pg/mL,(40.27±6.56) pg/mL in the control group (all P<0.05). The levels of IL-10 at the time of TI, T2, T3, T4 were (21.72±4.51) pg/mL, (28.27 ± 5.47) pg/mL, (33.25 ± 6.36) pg/mL, (38.43 ± 6.54) pg/mL, respectively, which were significantlyhigher than corresponding (19.24±3.42) pg/mL, (22.53±4.28) pg/mL, (26.43±5.34) pg/mL, (28.38±5.82) pg/mL of thecontrol group (all P<0.05). In the observation group, 12 hours, 24 hours, 48 hours, and 72 hours after surgery, the levelsof FVC of respiratory function and FEV1 were (54.38±5.39)%, (57.58±6.34)%, (60.23±6.43)%, (63.45±8.49)% and(36.56±4.34)%, (43.43±5.39)%, (50.39±6.34)%, (57.25±7.17)%, respectively, which were sign