右美托咪定对单肺通气患者动脉血气和炎性因子的影响  

Influence of dexmedetomidine on arterial blood gas and inflammation cytokines in patients with one-lung ventilation

作　　者：朱焱林[1] 蒋亚欧 肖红波[1] 刘明基[1] 杜海靖[1] 孙建明[1] 

机构地区：[1]江苏省靖江市人民医院麻醉科,214500

出　　处：《临床麻醉学杂志》2017年第11期1070-1073,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨右美托咪定对单肺通气(OLV)患者动脉血气和炎性因子的影响。方法选择择期肺癌根治术患者62例,性别不限,年龄34~69岁,ASAⅠ或Ⅱ级。按照收治先后顺序分成观察组和对照组,每组31例。所有患者静脉注射舒芬太尼0.3~0.5μg/kg、丙泊酚1.5~2.5mg/kg、咪达唑仑0.5 mg/kg、罗库溴铵0.9 mg/kg行麻醉诱导;静脉输注丙泊酚6~8 mg·kg^(-1)·h^(-1)、瑞芬太尼0.1~0.5μg·kg^(-1)·min^(-1),间断静脉注射顺式阿曲库铵进行麻醉维持。观察组患者于麻醉诱导前10min静脉输注右美托咪定1.0g/kg,10min输注完,之后维持0.5μg·kg^(-1)·h^(-1)速率输注至手术结束前30min。对照组则输注等量的生理盐水。分别于OLV前即刻(T0)、OLV 1h后(T1)、OLV结束时(T2)采集桡动脉血,检测血气(pH、PaO_2、PaCO_2)和炎性因子(TNF-α和IL-6)。记录两组手术结束后丙泊酚用量。结果与T0时比较,T1、T2时两组pH、PaO_2明显降低,PaCO_2明显升高,TNF-α和IL-6含量明显升高(P<0.05);T1、T2时观察组PaO_2明显高于对照组(P<0.05),PaCO_2明显低于对照组(P<0.05),TNF-α和IL-6含量明显低于对照组(P<0.05)。两组围术期顺式阿曲库铵用量和瑞芬太尼用量差异无统计学意义,观察组丙泊酚用量明显低于对照组(P<0.05)。结论右美托咪定有助于维持单肺通气患者术中血气稳定,减轻单肺通气引起的炎症反应。Objective To explore the influence of dexmedetomidine on blood gas and inflammation cytokines in patients with one-lung ventilation（OLV）.Methods Sixty-two patients undergoing radical resection of pulmonary carcinoma were divided into observation group and control group in sequence,31 cases in each group.All patients treated with intravenous sufentanil 0.3-0.5μg/kg,propofol 1.5-2.5 mg/kg,midazolam 0.5 mg/kg and rocuronium 0.9 mg/kg for induction of anesthesia;intravenous infusion of propofol 6-8 mg·kg-1·h-1 and remifentanil 0.1-0.5μg·kg-1·min-1,intermittent intravenous injection of cisatracurium for anesthesia maintenance.The patients in the observation group were given 1μg/kg loading dose dexmedetomidine 10 min before anesthesia induction（infusion in 10 min）,maintaining at 0.5μg·kg-1·h-1 until 30 min before the end of surgery.The patients in the control group were given the same amount of saline as a control.The blood gas analysis index,pH,partial oxygen pressure（PaO2）,CO2 partial pressure（PaCO2）and such inflammation cytokines as tumor necrosis factor alpha（TNF-α）and interleukin 6（IL-6）at OLV（T0）,after OLV1 h（T1）,the end of OLV（T2）were respectively tested,the dosage of propofol in the two groups were recorded.Results The dosage of propofol in observation group was significantly lower than that in the control group（P〈0.05）;pH declined in the two groups（P〈0.05）,but the difference had no statistical significance;PaO2 was rising then declined in the two groups（P〈0.05）,but it was significantly higher in the observation group than in the control group（P〈0.05）;PaCO2 in the two groups increased gradually（P〈0.05）,it was significantly lower in the observation group than in the control group（P〈0.05）;The serum TNF-α,IL-6 in the two groups showed a trend of increasing（P〈0.05）,it was significantly lower in the observation group than in the control group（P〈0.05）.Conclusion Dexmedetomidine can maintain blood gas stability and reduce i

关 键 词：右美托咪定 单肺通气 血气分析 炎性因子 

分 类 号：R614[医药卫生—麻醉学]