右美托咪定对单肺通气期间肺内分流及动脉血氧合功能的影响  

Effects of dexmedetomidine on intrapulmonary shunt and arterial oxygenation during one- lung ventilation

作　　者：薛峰[1] 陈作雷[1] 刘翠翠[1] 王世端[1] 

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266003

出　　处：《中国新药与临床杂志》2015年第11期861-865,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的探讨右美托咪定对胸腔镜肺叶切除术患者单肺通气时肺内分流及动脉血氧合功能的影响。方法择期行胸腔镜肺叶切除术患者60例，随机分为两组，每组30例。试验组麻醉诱导前经静脉缓慢泵入右美托咪定0．6μg·kg-1，手术开始后以0．4μg·kg-1·h-1持续泵入，对照组同法泵入氯化钠注射液，开始关胸时停止。两组均靶控输注丙泊酚和舒芬太尼进行麻醉诱导及维持，肌松满意后插管，行机械通气。于麻醉诱导后双肺通气30min（T0），单肺通气15min（T1）、30min（T2）、1h（T3）和恢复双肺通气30min（T4）时测定中心静脉压（CVP）、平均有创动脉压（MAP）、心率（HR）、脑电双频指数（BIS）和气道平均压（Pmean），同时采集颈内静脉和桡动脉血样，进行血气分析，计算肺内分流率（Qs／Qt），记录两组麻醉药用量等。结果两组单肺通气时间和手术时间无显著差异，CVP、MAP、HR和BIS在各观察时点均无显著差异（P〉0．05）。与T0时比较，两组T1～T3时Pmean和Qs／Qt显著升高（P〈0．05）；与T1时比较，两组T2、T3时Qs／Qt显著降低（P〈0．05）；两组间各时点动脉血氧分压、动脉血二氧化碳分压、脉搏血氧饱和度、Pmean和Qs／Qt比较均无显著差异（P〉0．05）。试验组舒芬太尼、丙泊酚用量低于对照组．麻黄碱用量高于对照组（P〈0．05），未见明显不良反应发生。结论右美托咪定对胸腔镜肺叶切除术患者单肺通气期间肺内分流及动脉血氧合功能无明显影响，可安全应用在单肺通气的手术中。AIM To investigate the effects of dexmedetomidine oxygenation during one- lung ventilation in patients undergoing thoracic ASA I orⅠ, scheduled for lung cancer resection, were randomly divided Dexmedetomidine 0.6 μg.kg-1 in 50 mL of sodium chloride injection on intrapulmonary shunt and arterial surgery. METHODS Sixty patients, into two groups （30 patients in each）. was injected slowly before inductionof anesthesia in the trial group followed by an infusion of 0.4 μg.kg-1.h-1, while in the control group sodium chloride injection was injected instead of dexmedetomidine. Anesthesia was induced and maintained with target controlled infusion of propofol and sufentanil. Double lumen tube was inserted under satisfactory degree of muscle relaxation and followed by machinery ventilate. MAP, HR, CVP, BIS and mean airway pressure （Pmean） were monitored and recorded at two-lung ventilation 30 rain after anesthesia induction （T0）, 15, 30 min and 1 h of OLV （T1 - T3） and 30 min after reexpansion of the collapsed lung （T4）. Blood samples were taken simultaneously from jugular vein and radial artery for blood gas analysis. Intrapulmonary shunt （Qs/Qt） was calculated. The consumption of sufentanil, propofol and ephedrine were recorded. RESULTS There was no significant difference in the operation time and one-lung ventilation time between the two groups （P 〉 0.05）. There was no significant difference in MAP, HR, CVP, BIS at each observed time point between the two groups （P 〉 0.05） . Compared with those at To, Pmean and Qs/Qt were significant higher in T1 - T3 in both groups （P 〈 0.05）. Compared with those at T1, Qs/Qt were significant lower at T2 and T3 in both groups （P 〈 0.05）. There was no significant difference in PaO2, PaCO2, SpO2, Pmean and Qs/Qt at each time point between the two groups （P 〉 0.05）. The consumption of sufentanil and propofol were significantly lower and the consumption of ephedrine was significantly higher in the trial group than control group （P

关 键 词：右美托咪定 缺氧 血管收缩 单肺通气 

分 类 号：R971[医药卫生—药品]