Effects Of Dexmedetomidine On Micro-metastasis In Patients Undergoing Radical Operation For Lung Cancer

Objective: The study selected elderly patients with lung cancer,undergoing thoracoscopic surgery,during which dexmedetomidine was continuous intravenous infusion and used during postoperative for patient-controlled analgesia,and effects of dexmedetomidine on Evaluation radical resection of lung cancer patients during the perioperative period of micro metastasis,and provide reference for elderly patients with lung cancer surgery during anesthesia medication.Methods: patients undergoing thoracoscopic lung cancer radical operation in 40 cases of elderly patients,male or female,age 60-69,BMI-19²5kg/m²,ASA ???.Using the method of random number table according to gender,lung cancer and ipsilateral side of different lobes were randomly divided into two groups: one group application of intraoperative dexmedetomidine?group D,n=20?,and the other one without the use of dexmedetomidine group?group C,n=20?.After entering the upper limb vein,the establishment of upper limb vein access,intravenous midazolam 0.02mg/kg,before the induction intubation intravenous infusion of Compound Sodium Chloride Injection 6ml/kg pre expansion.Intravenous sufentanil 0.3 0.4 g / kg,propofol 1.5 to 2 mg / kg,Shun atracurium 0.2mg/kg.In the BIS reduced to 40 50,TOF is equal to 0 or endobronchial intubation,pick Leon anesthesia machine,mechanical ventilation,and two lung ventilation set tidal volume 8ml / kg,RR for 12 bpm,suction call ratio is 1: 2,intravenous infusion of remifentanil 0.4ng/ml propofol target controlled concentrations of 2 3?g / ml for maintenance of anesthesia.Central venous catheterization via right internal jugular vein.Successful intubation,patients in the lateral decubitus position,after the start of operation,single lung ventilation,set tidal volume to 6ml / kg,respiratory frequency is 15 times / min,suction call ratio of 1:2.Group D with 1 g/kg of dexmedetomidine infusion,infusion time 10 min,followed by 0.3 g/kg/h rate until 20 min before the end of the operation.In the control group,the volume of normal saline was infused.20 min after intubation to regulate the target controlled infusion of remifentanil and propofol,to maintain the level of BIS in the 45⁵5.During the test,MAP < 55 mmHg,duration of more than 5min,the static injection of norepinephrine to correct;HR < 45 times /min,duration of more than 5min,intravenous atropine correction.The MINDRAY-BeneViewT5 vital signs monitor routine monitoring of electrocardiogram?ECG?,pulse oxygen saturation?SPO₂?and BIS.Edwards sensor neutral grounding via radial artery puncture,connecting the average artery MINDRAY-BeneViewT5 vital signs monitor to monitor the pressure?map?,systolic blood pressure?SBP?and diastolic blood pressure?DBP?,heart rate?HR?.After the operation is completed,each monitoring data is stable,the data of each group is recorded as the basic value,and the monitoring value of each time point is recorded.Including: baseline?T₀?,before intubation?T₁?,immediately after intubation?T₂?and dexmedetomidine set before infusion?T 3?,dexmedetomidine set infusion for 20 min?T₄?,and every 5 min recording time(T_5¹5),vital signs,until stable bis 50 min after and before the surgery was completed 20 min stop infusion of dexmedetomidine set,postoperative(T₁₆),postoperative 48h(T₄₈).In T₃,T₁₆ and T₄₈ from the central vein of 2ml,detected by RT-PCR in the blood of cytokeratin 19?CK19?,lung-specific X protein?LUN-X?expression,recorded positive expression.Results:1 Comparison of the general situationTwo groups of patients with age,sex ratio,body mass index,lung cancer cases than the left and right side,and the side lobe with different number of cases than there was no significant difference?P>0.05?.2 Hemodynamic indexesSBP:Compared with the values T₀,two in group T₁ decreased immediately after the start of induction,when the group D compared to the baseline values?t=4.8,P<0.05?T₀ decreased immediately after intubation,the rise of T₂,then began to decline,tended to be stable;group C compared with the T₀ based?t=5.829,P<0.05?decreased,T₁ increased and then began to decline,tended to be stable,there was no significant difference between the two groups?P>0.05?.MAP:Compared with the values T₀,two in group T₁ decreased immediately after the start of induction,when the group D compared to the baseline values?t=4.333,P<0.05?T₀ decreased immediately after intubation,the rise of T₂,then began to decline,tended to be stable;group C compared with the T₀ based?t=5.271,P<0.05?decreased,immediate intubation increased after T₂,then began to decline,tended to be stable,there was no significant difference between the two groups?P>0.05?.DBP:Compared with the baseline values,two groups to start immediately after T₁ induced decline in group D decreased compared with baseline values?t=3.284,P>0.05?,immediately after intubation increased T₂,then began to decline,tended to be stable;group C compared with the T₀ based?t=5.736,P>0.05?decreased immediately after intubation,rose T₂ and then began to decline,tended to be stable,there was no significant difference between the two groups?P>0.05?.HR:Compared with the baseline values,in group D after induction of T₀ decreased and T₁ increased,the application of dexmedetomidine after 20 mins was decreased?t = 11.447,P < 0.05?,then stabilized.in group.C after induction of T₀ decreased and T₁ increased,T₃ decreased slightly,remained stable,the two groups no statistical significance?P>0.05?,the heart rate of the two groups was statistically significant?t=6.946,P<0.05?.Ct:Compared with the maintenance of BIS45⁵5 between the basic value,group D iv dexmedetomidine after 20 min BIS obvious change,adjust the concentration of propofol in plasma,recovery of BIS?50±3?,Ct decreased significantly?t = 25.325,P < 0.05?: Group C had no obvious change,compared with the group D based value was not statistically significant?t=0.435,P>0.05?after Ct,a stable BI value was statistically significant?t=29.296,P<0.05?.BIS:The basic value of group D?94±2?,C group?94±2 base value?,the two groups was not statistically significant?t=0.237,P>0.05?.Group D after using dexmedetomidine 20 min,BIS decreased,compared with the basic value decreased?t=27.067,P<0.05?;group C with normal saline after 20 min,BIS values did not change significantly,there was statistically significant difference between the two groups?t=27.855,P<0.05?.CK19:The patients in the T₃?T₁₆ positive expression rate of CK19 between the groups was not statistically significant?P>0.05?;compared with group C,group D,positive expression decreased?P<0.05?in the T₄₈,the difference was statistically significant.LUNX:The patients in the T₃?T₁₆ positive expression rate of CK19 between the groups was not statistically significant?P>0.05?;compared with group C,group D,positive expression decreased?P<0.05?in the T₄₈,the difference was statistically significant.Conclusion:Perioperative application of dexmedetomidine can help reduce lung cancer surgery in elderly patients with hematogenous micrometastasis rate,promote prognosis.