右美托咪定对亲体肝移植术婴儿术后肺损伤的影响

Effect of dexmedetomidine on lung injury in infants undergoing liver transplantation

中文关键词: 右美托咪定  肝移植  婴儿  肺损伤

英文关键词: Dexmedetomidine  Liver transplantation  Infant  Lung injury

中文摘要:

      
目的 观察右美托咪定对亲体肝移植术婴儿术后肺损伤的影响。
方法 选择2019—2020年行择期亲体肝移植患儿120例，男56例，女64例，年龄4～12个月，ASA Ⅱ或Ⅲ级。采用随机数字表法将患儿分为两组：右美托咪定组（D组）和对照组（C组），每组60例。D组于麻醉诱导后静脉输注负荷剂量右美托咪定1 μg/kg，持续泵注10 min，随后以0.3 μg·kg^-1·h^-1持续静脉泵注至术毕，C组持续输注相同容量生理盐水至术毕。分别于麻醉诱导后（T1）、无肝期后30 min（T2）、缺血-再灌注后1 h（T3）、关腹即刻（T4）和术后24 h（T5）采集中心静脉血3 ml，采用ELISA法检测血清克拉拉分泌蛋白16（CC16）、表面活性蛋白（SP-D）、高级糖基化终末产物可溶性受体（sRAGE）、IL-6、TNF-α浓度；记录T1—T4时HR、MAP、CVP。记录手术时间、无肝期时间、术中失血量、输血量、输血浆量和尿量。记录术后拔管时间（手术结束至ICU拔除气管插管时间）、ICU停留时间；记录术后1周内急性肺损伤（ALI）、肺部感染、胸腔积液、肺不张、急性呼吸窘迫综合征（ARDS）、呼吸衰竭再插管等发生情况。
结果 与T1时比较，T2—T5时两组血清CC16、SP-D、sRAGE、IL-6、TNF-α浓度明显升高（P＜0.05），T2时C组MAP明显降低，HR明显增快（P＜0.05）。与C组比较，T2—T5时D组血清CC16、TNF-α浓度明显降低，T2和T3时D组SP-D、sRAGE、IL-6浓度明显降低（P＜0.05），D组术后ALI、肺部感染和ARDS发生率明显降低，术后拔管时间明显缩短（P＜0.05）。
结论 右美托咪定能够抑制肺损伤标记物及炎性因子释放，稳定血流动力学，减轻术后肺损伤。

英文摘要:

      
Objective To observe the effect of dexmedetomidine on postoperative lung injury in children undergoing liver transplantation.
Methods A total of 120 children undergoing elective related liver transplantation from 2019 to 2020, 56 males and 64 females, aged 4-12 months, ASA physical status Ⅱ or Ⅲ, were selected. Children were randomly divided into two groups (n = 60) using a computer-generated random number table: dexmedetomidine group (group D) and control group (group C). After induction of anesthesia, dexmedetomidine was infused in a loading dose of 1 μg/kg for 10 minutes followed by a continuous infusion of 0.3 μg·kg^-1·h^-1 in group D. The equal volume of 0.9% normal saline was given instead in group C until the end of operation. Immediately after anesthesia induction (T1), at 30 minutes of anhepatic phase (T2), at 1 hour of neohepatic phase (T3), immediately after peritoneum closure (T4), and at 24 hours after operation (T5), blood samples were collected from the central vein to detect the content of clara cell secretory protein (CC16), surfactant proteins D (SP-D), soluble receptor for advanced glycation end-products (sRAGE) and concentrations of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum by ELISA. MAP, HR, and CVP at T1-T4 were recorded. Operation time, anhepatic time, intraoperative blood loss, urine output, blood transfusion and plasma transfusion were record. Postoperative extubation time and ICU length of stay were recorded. Incidence of postoperative acute lung injury (ALI), lung infection, pleural effusion, atelectasis, acute respiratory distress syndrome (ARDS) and reintubation because of respiratory failure within one week were recorded.
Results Compared with T1, the level of CC16, SP-D, sRAGE, IL-6 and TNF-α were increased significantly at T2-T5(P < 0.05). Compared with group C, the concentrations of CC16, TNF-α were significantly decreased at T2-T5 and the concentrations of SP-D, sRAGE and IL-6 were significantly decreased at T2 and T3 in group D (P < 0.05). MAP was decreased and HR was increased at T2 in group C (P < 0.05). The incidence rate of ALI, lung infection and ARDS were significantly lower in group D than that in group C, and the extubation time was shorter in group D (P < 0.05).
Conclusion Dexmedetomidine inhibits the release of lung injury markers and inflammatory factors, stabilize hemodynamics, and reduce postoperative lung injury.