右美托咪定预处理对食管癌根治术单肺通气联合持续气道正压患者肺通气及氧合功能的影响  

Effect of dexmedetomidine preconditioning on pulmonary ventilation and oxygenation function of patients undergoing esophageal carcinoma radical surgery and received one-lung ventilation combined with continuous positive airway pressure

作　　者：徐开兴 张全云[1] 张晓群[1] 孟凡珍[1] 

机构地区：[1]江苏省连云港市第二人民医院麻醉科,222000

出　　处：《齐齐哈尔医学院学报》2016年第7期849-851,共3页Journal of Qiqihar Medical University

摘　　要：目的研究右美托咪定预处理对食管癌根治术单肺通气联合持续气道正压患者肺通气和氧合功能的影响。方法择期食管癌根治术患者40例,ASA分级Ⅱ~Ⅲ,性别不限,年龄45~70岁,BMI≤30 kg/m^2,采用随机数字表法将其分为2组(n=20):对照组(C组)、右美托咪定组(D组)。D组入室前2 h经静脉输注右美托咪定负荷量1.0μg/kg,时间>10min,再以0.2μg·kg^(-1)·min^(-1)持续输注至麻醉诱导前10 min调整为0.6μg·kg^(-1)·min^(-1),关胸后恢复为0.2μg·kg^(-1)·min^(-1)至拔除气管导管;C组给予等容生理盐水。切皮开始各组均行OLV,非通气侧肺CPAP维持6 cmH_2O,记录患者术中HR、SBP、DBP、MAP变化;采集动脉血检测PaO_2、PaCO_2并计算P(A-aDO2)、RI、OI值。结果与C组比较,D组患者拔管时间缩短(P<0.05)。D组HR于T_(2~6)时减低,SBP、DBP、MAP于T_(5~6)时减低而PaO_2、OI增高,PaCO_2、P(A-aDO_2)、RI于T_6时降低(P<0.05);与T_1时比较,两组患者SBP、DBP、MAP于T_(3~4)降低,P(A-aDO_2)于T_6增高,C组患者HR、SBP、DBP、MAP于T_(3~6)时增高,PaO_2于T_(4~6)时减低而PaCO_2趋于增高,RI于T_(5~6)时增高,OI于T_(3~6)时降低,D组OI于T_(4~5)时降低(P<0.05)。结论右美托咪定预处理即可维持食管癌根治术患者术前良好精神神经状态,在一定程度上改善了非通气侧肺组织的氧供,术后麻醉苏醒平稳,通气和氧合功能显著改善。Objective To investigate the effect of dexmedetomidine preconditioning on pulmonary ventilation and oxygenation function of patients undergoing esophageal carcinoma radical surgery and received one- lung ventilation combined with continuous positive airway pressure.Methods Forty patients who would chose a good time to do esophageal carcinoma radical surgerywere enrolled in the study,ASA physical status concentrated between Ⅱ and Ⅲ,no limited togender,aged from 45 to 70 years,with body mass index ≤30kg/m2,they were randomly assigned into 2 groups（n = 20 in each group） using a random number table：control group（group C） and dexmedetomidine group（group D）.In D group,a loading dose of dexmedetomidine lug/kg was infused intravenously 2 hours before operation,followed by infusion at a dose of 0.2ug·kg- 1·h- 1 until10 min before anesthesia induction,then adjust to 0.6ug·kg- 1·h- 1 to the chest was closed,restore the dose to 0.2ug·kg- 1·h- 1 until the extubation.The equal volume of normal saline was given in group C.At the beginning of skin incision,OLV was performed with CPAP 6 cmH20 on the non- ventilated side.The HR,SBP,DBP and MAP were recorded during operation.Arterial blood samples were taken for blood gas analysis,the PaO2 and PaCO2 were recorded,and P（A- aDO2） RI and OI were calculated.Results Compared with group C,there was a significant shorten at extubation time in group D（P〈0.05）.In group D,the HR was decreased at T2- 6,and SBP,DBP and MAP were decreased at T5- 6 while the PaO2 and OI were increased,PaCO2 and P（A-aDO2） and RI were decreased at T6 compared with group C（P〈0.05）.Compared with T1,the SBP,DBP and MAP were significant decreased at T3- 4,and P（A- aDO2） was increased at T6 both in groups C and D.In group C,the HR,SBP,DBP and MAP were increased at T3- 6,and PaO2 was decreased at T4- 6 while the PaCO2 was increased,the RI was increased at T5- 6.The OI was decreased at T4- 5 in group D（P〈0.05）.Conclusions Dexmedetomidine preconditioning can maintain

关 键 词：右美托咪定 呼吸 人工 连续气道正压通气 氧合 

分 类 号：R735.1[医药卫生—肿瘤]