右美托咪定对食管癌根治术患者单肺通气期间氧合作用的影响  

Effects of dexmedetomidine on oxygenation during one-lung ventilation for esophagectomy

作　　者：马小翠 王泓波[1] 唐涛 黄泽清[1] 

机构地区：[1]辽宁省肿瘤医院麻醉科,沈阳110042 [2]辽宁省肿瘤医院神经外科,沈阳110042

出　　处：《中国医师进修杂志》2017年第12期1076-1080,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 评估全身麻醉单肺通气期间,右美托咪定对缺氧性肺血管收缩和氧合作用的影响.方法 选取56例择期行食管癌根治术患者,根据随机数字表法分为右美托咪定组和对照组.所有患者采用七氟烷-芬太尼维持麻醉.右美托咪定组在单肺通气10 min后输注右美托咪定[负荷量0.3 μg/kg 10 min,维持量0.6 μg/（kg·h）];对照组输注等量0.9%氯化钠溶液.麻醉过程中采集3次（T1：麻醉插管后双肺通气10 min时;T2：单肺通气10 min时;T3：右美托咪定持续输注60 min时）动脉血样本进行血气分析,用氧合指数[动脉血氧分压（PaO2）/吸入氧浓度（FiO2）]评估右美托咪定对氧合作用的影响.单肺通气期间记录低血压及心动过缓发生率、3次血气采集时间段内七氟烷呼气末浓度、脑电双频指数（BIS）以及麻黄碱和阿托品的用量.结果 两组各时间点pH值、动脉血二氧化碳分压（PaCO2）水平比较差异无统计学意义（P〉0.05）.两组T3时点氧合指数比较差异有统计学意义[（153.29 ± 19.00）mmHg（1 mmHg=0.133 kPa）比（117.79 ± 12.00）mmHg, 1 mmHg=0.133 kPa,P〈0.01].在使用右美托咪定之后（T3）,右美托咪定组的HR较对照组明显降低[（68 ± 11）次/min比（89 ± 13）次/min],同时右美托咪定组的七氟烷呼气末浓度也显著低于对照组[（2.9±0.8）%比（4.2±0.1）%],差异均有统计学意义（P〈0.01）.右美托咪定组术中阿托品用量、心动过缓发生率均显著高于对照组（P〈0.05）,而两组麻黄碱用量比较差异无统计学意义（P〉0.05）.结论 食管癌根治术患者全身麻醉单肺通气期间联合使用右美托咪定能够减少麻醉药物对缺氧性肺血管收缩的抑制作用,改善患者氧合功能.Objective To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction and oxygenation during one- lung ventilation （OLV） undergoing esophagectomy. Methods Fifty-six adult patients undergoing esophagectomy and requiring OLV were selected.During inhalational anesthesia with sevoflurane, patients were randomized to receive either dexmedetomidine （dexmedetomidine group,28 patients）or saline placebo（control group,28 patients）. The bolus dose of 0.3 μg/kg over 10 min followed by a maintenance dose of 0.6 μg/（kg·h）was used in dexmedetomidine group. The arterial blood gas samples were obtained to evaluate the effects of dexmedetomidine on oxygenation in three times：T1：double-lung ventilation 10 min after anesthetic intubation;T2：OLV 10 min;T3：60 min after continuous infusion of dexmedetomidine. Outcomes included differences in hemodynamic parameters（heart rate and mean arterial pressure）, end-tidal sevoflurane concentration, ephedrine dose and atropine dose.Results The levels of pH, arterial partial pressure of carbon dioxide（PaCO2）in two groups had no significant differences（P＆gt;0.05）.The level of oxygenation index in two groups at T3had significant difference： （153.29 ± 19.00） mmHg（1 mmHg=0.133 kPa）vs. （117.79 ± 12.00） mmHg, 1 mmHg = 0.133 kPa, P ＆lt; 0.01. At T3, the level of heart rate in dexmedetomidine group was significantly lower than that in control group：（68 ± 11）times/min vs.（89±13）tims/min;meanwhile, the level of end-tidal sevoflurane concentration in dexmedetomidine group was significantly lower than that in control group： （2.9 ± 0.8）% vs. （4.2 ± 0.1）%; there were significant differences （P ＆lt; 0.01）. The ephedrine dose in two groups had no significant difference（P＆gt;0.05）.Conclusions Dexmedetomidine may provide clinically relevant benefits by improving oxygenation and decreasing the requirement of inhalational anaesthetic agents, thereby limiting its effect on hypoxic pulmonary vasoconstric

关 键 词：右美托咪定 氧合指数 单肺通气 缺氧性肺血管收缩 

分 类 号：R614[医药卫生—麻醉学]