右美托咪定对慢阻塞肺患者腔镜手术时氧合和无效腔的影响  

Effect of Dexmedetomidine on Oxygenation and Dead Space Ventilation in Elderly Patients with Chronic Obstructive Pulmonary Disease

作　　者：易声华[1] 蒋宗明[1] 陈忠华[1] 陈文迪[1] Yi Shenghua;Jiang Zongming;Chen Zhonghua(Department of anesthesiology, Shaoxing People＇s Hospital（ Shaoxing Hospital of Zhe-jiang University,Zhejiang 312000,China)

机构地区：[1]绍兴市人民医院(浙江大学绍兴医院)麻醉科,312000

出　　处：《医学研究杂志》2018年第4期90-93,共4页Journal of Medical Research

基　　金：浙江省绍兴市公益性应用研究计划项目(2015B70059)

摘　　要：目的 探讨右美托咪定对老年中度慢性阻塞性肺疾病(COPD)患者择期行腹腔镜结直肠癌手术时氧合和无效腔通气的影响。方法 择期行腹腔镜结直肠癌手术COPD患者60例,按照随机数字表法分为两组(n=30):右美托咪定组(D组)和对照组(C组)。D组诱导前静注右美托咪定0.5μg/kg(>10min),随后0.3μg/(kg·h)泵注至术毕;C组给予相同容量的生理盐水。测定入室时(T_0)、气管插管成功后(T_1)、人工气腹体位后30min(T_2)和60min(T_3)动脉血气值。观察气管插管成功后(T_1)、人工气腹体位后30min(T_2)和60min(T_3)气道峰压(P_peak)、气道平台压(P_plat)和动态肺顺应性(C_dyn),计算无效腔率(V_D/V_T)和氧合指数(OI)。结果 与C组比较,D组T_2和T_3时点氧合指数均升高(P<0.05,P<0.01),P_peak下降和C_dyn显著升高(P<0.05,P<0.01);而两组间pH、PaCO_2和P_plat比较差异无统计学意义。麻醉后D组V_D/V_T呈降低趋势,与C组比较,D组T_2和T_3时点V_D/V_T显著下降(P<0.05)。结论 右美托咪定术中输注可显著降低中度COPD患者的气道压力,降低无效腔通气率,改善肺内氧合。Objective To investigate the effects of dexmedetomidine on oxygenation and dead space ventilation in elderly chronic obstructive pulmonary disease（COPD） patients undergoing laparoscopic colorectal surgery. Methods 60 patients undergoing laparoscopic colorectal surgery were randomly divided into 2 groups（n = 30） ： dexmedetomidine group（D group） and control group（C group）. D group received dexmedetomidine 0.5μg/kg（over 10 min） before induction,then 0.3μg/（kg · h） continuous infusion until the end of surgery; C group received equal amount of normal saline before inductio. Arterial blood gas analysis were measured when entering the room（T0）,after tracheal intubation（T1）,30 min（T2）,60 min（T3） after pneumoperitoneum and position. Peak airway pressure（Ppeak）,plateau airway pressure（Pplat） and dynamic lung compliance（Cdyn） were recorded at T1,T2 and T3,at the same time,calculating the rate of dead space（VD/VT） and oxygenation index. Results Compared with C group,at T2,T3 the oxygenation index of D group significantly increased（P〈0.05,P〈0.01）,the Ppeakvalue decreased and the Cdynvalue increased（P〈0.05,P〈0.01）; there is no significant difference between the two groups in pH,PaCO2 and Pplat. Compared with C group,the VD/VTof D group at T2 and T3 was significantly decreased（P〈0.05）. Conclusion Dexmedetomidine infusion can significantly reduce the intraoperative airway pressure in patients with moderate COPD,reduce the dead space ventilation rate,further improve lung oxygenation.

关 键 词：右美托咪定 慢性阻塞性肺疾病 无效腔 

分 类 号：R614[医药卫生—麻醉学]