Effects Of Different Doses Of Dexmedetomine On TNF-α,IL-6,IL-10 And Oxygenation Function During One Lung Ventilation

Objective:To investigate the effects of different doses dexmedetomidine on IL-6,IL-10,TNF-α、oxygenation function and adverse reaction during perioperative period in patients with one-lung ventilation（OLV）,and to explore the protective effect of DEX on lungs as well as appropriate maintenance dose of DEX during OLV,so that references could be provided to guide clinical practice.Methods:Sixty ASA I or II patients who are undergoing OLV during VATS were randomly allocated to three groups（n=20）:control group（group A）,low dosage Dex group（group B）and high dosage Dex group（group C）.In the group B and C,additional infusion of dexmedetomidine（1ug/kg）was administered 10 minutes before induction,and a continuous injection of dexmedetomidine(0.2ug·kg^-1·h^-1 and 0.5ug·kg^-1·h^-1 respectively)were infused until 30 minutes before the end of operation;While in group A,only normal saline was provided instead of Dex.Arterial blood samples were collected from the initial time of OLV（T₀）,at 60 min after OLV（T₁）,at 15 min after reexpansion of the collapsed lung（T₂）for monitoring TNF-α、IL-6、IL-10 and blood gas analysis.Oxygenation index was recorded at the same time.The consumption of propofol was recorded and adverse reaction were observd.Results:There was no significant difference in the general information,operation time and one-lung ventilation time between the three groups（P>0.05）.Compared with those at T₀,the levels of TNF-α,IL-6,IL-10 were significantly higher at the time of T₁ and T₂ in both groups（P<0.05）.Compared with group A,the levels of IL-6 in group B were lower at the time of T₁ and T₂（P<0.05）,the levels of TNF-αwere lower and the IL-10 were higher in group B at the time of T₂（P<0.05）;The levels of TNF-α,IL-6 were lower and the IL-10 were higher in group C at the time of T₁ and T₂（P<0.05）.Compared with group B,the levels of TNF-α,IL-6 were lower and the levels of IL-10 were higher in group C at the time of T₁ and T₂（P<0.05）.OI were significantly decreased at the time of T₁ and T₂ compared with T₀ in both groups（P<0.05）.Compared with group A,OI were higher in group B at the time of T₂,and in group C were higher at the time of T₁ and T₂（P<0.05）.Compared with group B,OI were higher in group C at the time of T₁ and T₂（P<0.05）.The consumption of propofol was remarkably lower in group B and C.Compared with group A and B,hypotention and delayed recovery occurred more frequently in group C（P<0.05）.Conclusion:Dexmedetomidine can reduce inflammatory reactions and improve oxygenation during one-lung ventilation.The protective effect of dexmedetomidine on the lungs was dose-dependent.The maintenance dose of 0.5 ug·kg^-1·h^-11 was more effective than0.2ug·kg^-1·h^-1 in inhibiting the release of inflammatory factors and improving the oxygenation function.However,as the dosage increases,adverse reactions such as hypotension and delayed recovery increase.For patients with poor physical conditions,a maintenance dose of 0.2 ug·kg^-1·h^-1 is more appropriate.