盐酸右美托咪定对重症肌无力手术患者肺功能的影响  

The effects of dexmetomidine hydrochloride on pulmonary function of patients with myasthenia gravis

作　　者：邱延伟 杨艳超[1] 李延峰[1] QIU Yanwei;YANG Yanchao;LI Yanfeng(First Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第一医院,050011

出　　处：《河北医药》2018年第21期3205-3208,3213,共5页Hebei Medical Journal

基　　金：河北省科学技术研究与发展计划项目(编号:162777158)

摘　　要：目的研究不同剂量的盐酸右美托咪定对重症肌无力手术患者肺功能的影响。方法选取择期行胸腔镜下胸腺切除术的重症肌无力患者40例,根据盐酸右美托咪定(DEX)术中持续泵入速度的不同,患者随机分为4组:生理盐水对照组(C组)、0.2μg·kg^(-1)·h^(-1)DEX组(D1组)、0. 4μg·kg^(-1)·h^(-1)DEX组(D2组)、0. 6μg·kg^(-1)·h^(-1)DEX(D3组),每组10例。D1组、D2组、D3组在麻醉诱导前10 min静脉输注DEX 1μg/kg,随后分别以0. 2μg·kg^(-1)·h^(-1)、0. 4μg·kg^(-1)·h^(-1)、0. 6μg·kg^(-1)·h^(-1)输注至手术结束,C组0. 9%氯化钠溶液对照。全麻诱导后,泵入丙泊酚3～5 mg·kg^(-1)·h^(-1),盐酸瑞芬太尼0. 1～0. 2μg·kg^(-1)·min^(-1),间断静注顺阿曲库铵,维持BIS值40～60。4组患者分别于T0(麻醉前)、T2(单肺通气30 min)、T3(单肺通气90 min)、T4(术后2 h)做动脉血气记录肺泡动脉血氧分压差[P(A-a) O_2]并计算氧合指数(Pa O_2/Fi O_2),T1 (插管即刻)、T2、T3、T4点记录监测气道峰压(Ppeak)。结果 P(A-a) O_2:与C组比较,D1、D2、D3组在T2、T3、T4时P(A-a) O_2降低(P <0. 05);与D1组比较,D2、D3组T4时P(A-a) O_2降低(P <0. 05);与D2组比较,D3组各时间点P(A-a) O_2差异无统计学意义(P> 0. 05)。与T0比较,各时间点4组P(A-a) O_2明显增高(P <0. 05)。Pa O_2/Fi O_2:与C组比较,D1、D2、D3组在T2、T3、T4时Pa O_2/Fi O_2均有增高(P <0. 05);与D1组比较,D2、D3组T3、T4时Pa O_2/Fi O_2增高(P <0. 05);与D2组比较,各时间点D3组Pa O_2/Fi O_2差异无统计学意义(P> 0. 05)。与T0比较,各时间点各组之间Pa O_2/Fi O_2降低(P <0. 05)。Ppeak:与C组比较,D2、D3组各时间点Ppeak降低(P <0. 05);与D1组比较,D3组T2时Ppeak降低(P <0. 05);与D2组比较,各时间点D3组Ppeak差异无统计学意义(P> 0. 05)。与T1比较,在各时间点各组Ppeak均增高(P <0. 05)。结论重症肌无力患者胸腔镜手术中,使用合适剂量的盐酸右美托咪定能够改善氧合,降低气道反应,发挥肺�Objective To investigate the effects of different doses of dexmedetomidine hydrochloride(DEX)on lung function of patients with myasthenia gravis.Methods Forty patients with myasthenia gravis undergoing thoracoscopic thymectomy surgery were enrolled in the study.According to the difference of the velocity of continuous pumping of DEX,these patients were divided into 4 groups,with 10 patients in each group.The patients in saline group(group C)were given same volume saline;the patients in group D1 were given DEX,0.2μg·kg^-1·h^-1;the patients in group D2 were given DEX,0.4μg·kg^-1·h^-1;the patients in group D3 were given DEX,0.6μg·kg^-1·h^-1.Moreover the patients in D1,D2,D3 groups were given DEX 1μg/kg by intravenous infusion at 10min before anesthesia induction,then given different doses of DEX until the end of operation.The arterial blood gas indexes including PaO 2,PaCO 2,[P(A-a)O 2]and(PaO 2/FiO 2)were recorded before anesthesia(T0),one lung ventilation for 30 minutes(T2),one lung ventilation for 90 minutes(T3)and 2 hours after operation(T4).In addition the peak airway pressure(Ppeak)was monitored and recorded at T1(immediately after intubation),T2,T3 and T4.Results As compared with that in group C,the P(A-a)O 2 was significantly decreased at T2,T3,T4 in D1,D2,D3 group(P<0.05).As compared with that in D1 group,the P(A-a)O 2 was significantly decreased at T4 in D2 group,D3 group(P<0.05).As compared with that in D2 group,there was no significant diffference in P(A-a)O 2 in difference time pionts in D3 group(P>0.05).As compared with that at T0,the P(A-a)O 2 was significantly increased in every time point in the four groups(P<0.05).As compared with that in group C,the PaO 2/FiO 2 was significantly increased at T2,T3,T4 in D1,D2,D3 group(P<0.05).As compared with that in D1 group,the PaO 2/FiO 2 was significantly increased at T3,T4 in D2 group,D3 group(P<0.05).As compared with that in D2 group,there was no significant diffference in PaO 2/FiO 2 in difference time pionts in D3 group(P>0.05).As compared with t

关 键 词：重症肌无力 盐酸右美托咪定 胸腔镜下胸腺切除术 肺保护 

分 类 号：R971.2[医药卫生—药品]