| Objectives:To compare the effects of different doses of dexmedetomidine on human soluble intercellular adhesion molecule-1 （sICAM-1） and tumor necrosis factor- α （TNF-α） 、interleukin-6 （IL-6）, interleukin-10 （IL-10） in patients with lung cancer who underwent lung lobectomy with one lung ventilation and to investigate the effects of different doses effects of dexmedetomidine on perioperative inflammatory response and oxidative stress in patients with one lung ventilation and hemodynamics, and to provide some reference for clinical rational use of dexmedetomidine.Methods:Thirty patients from the Third Affiliated Hospital of Kunming Medical University. The patients from June 2016 to December 2016, aged 30 to 60, body weight 45 to 75 kg, the body weight index（BMI） are 18.5kg/m2 to 23.9 kg/m2, ASA physical status I or II. Preoperative pulmonary function of the indicators of normal or only mild pulmonary dysfunction. Thirty patients in accordance with the random number table, were divided into three groups. （Blank control group,no using test drugs: Group C, n=10, high Dexmedetomidine dose group : Group Di , n=10, low Dexmedetomidine dose group : Group D2, n=10）. The patients of preoperative pulmonary function indicators were normal. Eligible patients before surgery without hypertension,diabetes, chronic obstructive pulmonary disease, blood disease and other metabolic diseases,no respiratory tract infection within a week history of infection,no glucocorticoid and antioxidants （such as compound vitamins, etc.） use history and preoperative myocardial enzymes, liver and kidney function and other tests without exception, no chemotherapy before chemotherapy, radiotherapy, mechanical ventilation history. After induction of anesthesia, D1 group was given Dexmedetomidine at a load of lug/kg 10 min and followed by 0.5ug·kg-1 h-1 continuous infusion, D2 group was given Dexmedetomidine at a load of 0.5ug/kg 10 min and followed by 0.3ug·kg-1·h-1 continuous infusion, patients in Group C were infused ,with the same volume of saline by the same method. Three groups of patients were target-controlled infusion of propofol （plasma target control concentration of 3 ～ 5ug/ml）, continuous micro-injection of remifentanil 0.1 ～ 0.2 ug·kg-1 h-1 to maintain the body anesthesia, intermittent addition of vecuronium. Bispectral index（BIS） was monitored and maintained 40～60 during anesthesia. Three groups of anesthesia induction and maintenance of the same drugs and instruments are used to ensure that the same anesthesia depth. The observed and recorded indicators were:arterial blood 6 ml was collected to monitor sICAM-1、TNF-α、IL-6、IL-10 respectively at five time points,namely,after entering the operating room（T0）、one lung ventilation instantly（T1） 、45min after one lung ventilation（T2） 、 90min after one lung ventilation（T3）、45min after two lung re-ventilation（T4）.Simultaneously, at each time point,MAP、HR values were recorded. The levels of sICAM-1、TNF-α、IL-6 and IL-10 were measured and the varying trends were observed.Results:1. General Information and Data of Intraoperative1.1 There were no significant differences between three groups in general information（gender, age, weight, BP, HR）. The data of infusion quantity, blood loss,operation time, anesthesia time, one-lung ventilation time were no significant differences.（P > 0.05 ）2.The results of patients’ serological indicator in three groups2.1 IL-6In group comparison: Compared with T0, the concentration change in T1 was not significant, the concentration of IL-6 in T2, T3, T4 increased （P< 0.05）,especially in the group of control group（P<0.01）.Group comparison: There were significant differences between D1 group and C group in T3, T4 （P<0.05 ） , so the IL-6 concentration of Di group is lower than C group.2.2 IL-10In group comparison: Compared with To, the concentration of IL-10 in T1, T2,T3, T4 is increased （P<0.05）.Group comparison: There were significant differences between Di group, D2 group in T3, T4 and C group （P< 0.05）,so the IL-10 concentration of D1 group in T4 is higher than D2 group. There were significant differences between D1 group in T4 and C group （P<0.01） , so the IL-10 concentration of Di group is higher than C group.2.3 sICAM-1In group comparison: Compared with T0, the concentration change in Ti was not significant, the concentration of sICAM-1 in T2, T3, T4 increased （P<0.05）.Group comparison: There were significant differences between Di group, D2 group in T4 and C group （P< 0.05）. There were no significant differences between Di group,D2 group in sICAM-1 concentration。2.4 TNF-αIn group comparison: Compared with To, the concentration of IL-6 in Ti to T4 increased （P<0.05）, especially in the group of C group（P<0.01）.Group comparison: There were significant differences between Di group in T3,T4 group and D2 group（P <0.05 ）,so the TNF-a concentration of Di in T3, T4 group is lower than D2 group. The TNF-a concentration of C group in Ti to T4 group is lower than D1 group , D2 group. （P<0.05 ）.3. Comparison of hemodynamics in three groups:3.1 Comparison of heart rate （HR） results:In group comparison : Compared with T0, Di group in T1～T4 HR significantly slowed down （P <0.01）. There was no significant difference between group D2 and group C （P> 0.05）.Group comparison: Compared with D2 group and C group, the HR in Di group in Ti ～T4 was significantly lower than that in D2 group and C group （P <0.05）.3.2 Mean arterial pressure （MAP） comparison results:Compared with group C, Di and D2 were significantly decreased in T3 and T4 （P<0.05）.Group comparison: There was no significant difference （P> 0.05）.4. Comparison of urine output:In group comparison : There was no significant difference （P> 0.05）.Group comparison: Di group compared with C group, Di group increased urine output, a statistically significant （p <0.05）.Conclusions:1.Intraoperative use of dexmedetomidine hydrochloride could significantly reduce the stress caused by various factors during surgery to maintain hemodynamic stability and reduce TNF-a, sICAM-1, IL-6 release and promote the production of anti-inflammatory cytokine IL-10 during one lung ventilation（OLV）, enhance the body’s antioxidant capacity.2.The effect of dexmedetomidine hydrochloride on OLV-induced oxidative stress was associated with its dose. The effect of inhibit oxidative stress induced by OLV namely giving load dose lug/kg and then followed by 0.5ug·kg-1·h-1 continuous infusion（high Dexmedetomidine dose group） was better than that giving load dose 0.5ug/kgand then followed by 0.3ug·kg-1-h-1 continuous infusion（low Dexmedetomidine dose group）. |
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