| Objective:To observe the clinical effect of dexmedetomidine in thoracoscopic surgery under laryngeal mask anesthesia combined with epidural anesthesia,and to explore its pulmonary protective effect and inflammatory response.Methods:Thirty-five patients,ASA Ⅰ or Ⅱ grade,who were scheduled to undergo thoracoscopic bullae resection on November 1,2019 and December 31,2020 were selected and divided into control group(group C,n=17)and dexmedetomidine group(group D,n=18)by random number table method.Patients in both groups were treated with thoracic epidural block after admission,and after successful anesthesia,general anesthesia was performed with intravenous induction and laryngeal mask placement,and spontaneous breathing was retained during the operation.Propofol(4～8mg/kg/h)and remifentanil(0.03-0.08ug/kg/min)were used for intravenous anesthesia to maintain BIS between 40 and 60.The group D received intravenous infusion of dexmetomidine 0.5ug/kg as load during induction of general anesthesia.The Infusion was finished in 15 minutes,and then maintained with 0.4μg.kg-1.h-1 until the end of the operation.The group C was given the same dose of normal saline.After surgery,2mg morphine was given in the spinal canal of both groups,combined with Patient-controlled intravenous analgesia(PCIA)for postoperative analgesia.The heart rate(HR)and mean arterial pressure(MAP)were recorded before anesthesia(T0),after epidural block(T1),immediately after thoracic cavity opening(T2),15min after thoracic cavity opening(T3),30min after thoracic cavity opening(T4),after surgery(T5),and after laryngeal mask removal(T6)in two groups.Before anesthesia(T0),30min after thoracic cavity opening(T4),and 15min after laryngeal mask removal(T7),3ml arterial blood was extracted through radial artery catheterization,and blood gas analysis and oxygenation index were calculated.Serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)concentrations were detected.Operation time,recovery time,occurrence of intraoperative adverse events(hypoxemia,bradycardia,hypotension)and perioperative dosage of propofol and remifentanil were recorded in two groups.Visual analogue score(VAS)of pain at rest and cough at 1h,6h,12h,24h and 48h after surgery,total number of postoperative pressure on analgesic pump and dosage of remedy analgesics were recorded in two groups.Postoperative recovery(nausea and vomiting,time to get out of bed,time to eat,and length of postoperative hospital stay)was recorded.Results:The HR of group C at T1 and T2 was significantly lower than that at T0(P<0.05).The HR of group D at T1,T2,T3,T4 and T5 was significantly lower than that at T0(P<0.05).Comparison between groups:The HR at T2 in group D was significantly lower than that in group C(P<0.05).But there was no significant difference between the two groups at other time points(P>0.05).The MAP of the two groups at T1,T2.T3,T4,T5 was significantly lower than that at T0(P<0.05),but there was no significant difference in MAP at each time point between the two groups(P>0.05).The oxygenation index at T4 was significantly lower than that at T0(P<0.05),and returned to the level before anesthesia at T7,which was significantly higher than that at T4 in both groups(P<0.05).The oxygenation index of group D was significantly higher than that of group C at T4(P<0.05).The pH at T4 and T7 in both groups was significantly lower than that at T0(P<0.05),while the pH at T7 was significantly higher than that at T4(P<0.05).There was no significant difference between the two groups at each time point(P>0.05).The PaCO2 at T4 and T7 in both groups was significantly higher than that at T0(P<0.05),while the PaCO2 at T7 was significantly lower than that at T4(P<0.05).There was no significant difference between the two groups at each time point(P>0.05).In group C,the concentrations of serum IL-6 and TNF-α at T4 and T7 were higher than those at T0(P<0.05).The concentrations of IL-6 and TNF-α in serum at T7 were also higher than those at T4(P<0.05).The concentrations of IL-6 and TNF-α in serum at T7 were also higher than those at T4 and T0(P<0.05).Comparison between groups:the serum IL-6 and TNF-α concentrations at T7 in group D were significantly lower than those in group C(P<0.05).The intraoperative dosage of propofol in group D was less than that in group C(P<0.05),but there was no significant difference in the dosage of remifentanil between the two groups(P>0.05).There was no significant difference in the incidence of bradycardia,hypotension and hypoxemia between the two groups(P>0.05).The awakening time in group D was significantly longer than that in group C(P<0.05).The VAS scores of rest and cough at 6 h,12 h and 24 h after operation in both groups were significantly higher than those at 1 h after operation(P<0.05).Comparison between groups:The resting VAS score of group D was lower than that of group C at 12 hours after operation(P<0.05),but there was no significant difference in postoperative cough VAS score between the two groups at each time point(P>0.05).The total number of analgesic pump press and the amount of remedial analgesics in group D were significantly lower than those in group C(P<0.05).There was no significant difference in the time of getting out of bed,eating,postoperative hospitalization and the incidence of nausea and vomiting between the two groups(P>0.05).Conclusions:1.As an adjuvant to anesthesia,dexmedetomidine can be safely used in the laryngeal mask anesthesia with reserved spontaneous breathing combined with epidural anesthesia in thoracoscopic bullae resection,which can reduce the perioperative dosage of propofol and improve the oxygenation index during spontaneous breathing and enhance the postoperative analgesic effect.2.Continuous infusion of dexmedetomidine during laryngeal mask anesthesia with reserved spontaneous breathing combined with epidural anesthesia in thoracoscopic bullae resection reduced the inflammatory response and had a certain protective effect on the lung,but attention should be paid to the decreased heart rate and prolonged postoperative recovery time after dexmedetomidine administration. |
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