右美托咪定对老年患者单肺通气期间氧合和呼吸力学的影响  

Effects of dexmedetomidine on oxygenation and lung mechanics in elderly patients during one lung ventilation

作　　者：卜丹[1] 叶伟光[1] 王天龙[1] BU Dan;YE Weiguang;WANG Tianlong(Department of Anesthesiology,Xuanwu Hospital,Capital Medical University,100053,China)

机构地区：[1]首都医科大学宣武医院麻醉科,100053

出　　处：《临床麻醉学杂志》2018年第7期631-634,共4页Journal of Clinical Anesthesiology

基　　金：北京市卫生和计划生育委员会"老年重大疾病关键技术研究"(PXM2017_026283_000002);北京市医院管理局"登峰计划"专项(DFL20150802)

摘　　要：目的观察右美托咪定对老年患者单肺通气期间氧合和呼吸力学的影响。方法择期行胸腔镜下肺叶切除术的老年患者60例,男32例,女28例,年龄65~77岁,BMI 20.3~27.9kg/m2,ASAⅡ或Ⅲ级。随机分为两组:右美托咪定组(D组)和生理盐水组(C组),每组30例。D组在单肺通气后10min内输注右美托咪定1.0μg/kg,然后以0.5μg·kg-1·h-1速率输注至单肺通气结束,C组输注等容量生理盐水。在单肺通气前1min(T0)、单肺通气后30min(T1)和单肺通气后60min(T2)各时点抽取桡动脉血2ml行血气分析,计算PaO2/FiO2。在T1和T2时进行呼吸力学监测,监测参数包括肺动态顺应性(Cdyn)、气道峰压(Ppeak)、气道平均压(Pmean)和无效腔气量与潮气量之比(VD/VT)。记录ICU停留时间和术后72h内的肺不张、肺炎、急性肺损伤等并发症情况。结果与T0时比较,T1和T2时两组PaO2/FiO2明显降低(P<0.05)。与C组比较,T1和T2时D组PaO2/FiO2和Cdyn明显升高(P<0.05),Ppeak、Pmean和VD/VT明显降低(P<0.05),ICU停留时间明显缩短(P<0.05),术后肺不张明显减少(P<0.05)。两组肺炎和急性肺损伤差异无统计学意义。结论老年患者单肺通气期间输注右美托咪定可以改善血液氧合和呼吸力学,不增加急性肺损伤的发生,可减少术后肺不张,缩短ICU停留时间。Objective To determine whether dexmedetomidine improves oxygenation and lung mechanics in elderly patients during one lung ventilation（OLV）.Methods Sixty elderly patients scheduled for lobectomy under video-assisted thoracoscopic surgery,aged 65-77 years,ASA physical statusⅡ orⅢ,were randomly allocated into group D or group C,30 patients in each group.In group D,dexmedetomidine was given as an initial loading dose of 1.0μg/kg over 10 min followed by a maintenance dose of 0.5μg·kg-1·h-1 during OLV while group C was administered same volume of0.9% saline.ABG was performed in 2 ml of radial artery at 1 min before OLV（T0）,30 min（T1）and 60 min（T2）after OLV,then PaO2/FiO2 was calculated respectively.Parameters of lung mechanics were monitored at T1 and T2 including Cdyn,Ppeak,Pmean and VD/VT.The length of ICU stay and adverse events such as pulmonary atelectasis,pneumonia and acute lung injury 72 hours after surgery were recorded.Results PaO2/FiO2 ratio in both groups at T1 and T2 were significantly lower（P〈0.05）than that at T0.Compared with group C,patients in group D had significantly higher PaO2/FiO2 ratio and Cdyn（P〈0.05）,lower Ppeak,Pmean and VD/VT（P〈0.05）,shorter stay of ICU（P〈0.05）and lower incidence of pulmonary atelectasis（P〈0.05）at T1 and T2.There was no significant difference in the incidence of pneumonia and acute lung injury between the two groups.Conclusion Dexmedetomidine administration may improve oxygenation and lung mechanics in elderly patients during OLV without increasing the incidence of acute lung injury,decrease the incidence of postoperative atelectasis and shorten ICU stay.

关 键 词：老年患者 单肺通气 右美托咪定 氧合 呼吸力学 

分 类 号：R614[医药卫生—麻醉学]