不同剂量右美托咪定对轻度阻塞性通气功能障碍老年患者腹腔镜胆囊切除术中肺功能的影响  

Effect of different doses of dexmedetomidine on lung injury during laparoscopic gallbladder surgery in elderly patients with mild obstructive ventilation dysfunction

作　　者：马纪 王海云[1] 华伟[1] 肖军章 牟洪颖 赵茗姝[1] 唐庆凯 Ma Ji;Wang Haiyun;Hua Wei;Xiao Junzhang;Mou Hongying;Zhao Mingshu;Tang Qingkai(Department of Anesthesiology,Tianjin Third Central Hospital Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases Tianjin Artificial Cell Engineering Technology Research Center Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Department of Anesthesiology,Tianjin Jizhou People's Hospital,Tianjin 301900,China)

机构地区：[1]天津市第三中心医院麻醉科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心天津市肝胆研究所,300170 [2]天津市蓟州区人民医院麻醉科,301900

出　　处：《中华麻醉学杂志》2019年第11期1352-1356,共5页Chinese Journal of Anesthesiology

基　　金：天津医学会麻醉学分会青年科研培育基金项目(TJMZJJ-2017-01)。

摘　　要：目的评价不同剂量右美托咪定对保护性通气下轻度阻塞性通气功能障碍老年患者腹腔镜胆囊手术时肺功能的影响。方法择期全身麻醉下行腹腔镜胆囊切除术患者120例,性别不限,年龄65~75岁,BMI 18.5~23.9 kg/m^2,ASA分级Ⅱ或Ⅲ级,术前肺功能检查合并轻度阻塞性通气功能障碍。采用随机数字表法将患者分为4组(n=30):常规组(C组)和不同剂量右美托咪定组(Dex1组、Dex2组和Dex3组)。Dex1组、Dex2组和Dex3组经10 min静脉输注右美托咪定1μg/kg,然后分别以0.2、0.4和0.6μg·kg^-1·h^-1的速率静脉输注右美托咪定至手术结束,C组给予等容量生理盐水。于气腹开始前即刻(T1)、气腹结束前即刻(T2)和气腹结束后10 min(T3)时记录气道峰压(Ppeak)、平均气道压(Pmean)、气道平台压(Pplat)和呼气末正压(PEEP),计算驱动压。采集桡动脉血样行血气分析,记录PaO2和PaCO2,计算氧合指数(OI)、呼吸指数(RI)、死腔通气率(VD/VT)和肺泡-动脉血氧分压差(A-aDO2)。记录气管拔管时间和术后48 h内高碳酸血症、低氧血症等的发生情况。结果与C组比较,Dex1组、Dex2组和Dex3组T1-3时Ppeak、Pmean和驱动压降低,OI升高,RI、VD/VT和A-aDO2降低,术中去氧肾上腺素和阿托品用量增加,气管拔管时间缩短,术后低氧血症发生率降低(P<0.05);与Dex1组比较,Dex2组和Dex3组T1-3时Ppeak、Pmean和驱动压降低,OI升高,RI、VD/VT和A-aDO2降低,Dex3组术中去氧肾上腺素和阿托品用量增加(P<0.05);与Dex2组比较,Dex3组术中去氧肾上腺素和阿托品用量增加(P<0.05)。结论右美托咪定改善轻度阻塞性通气功能障碍老年患者腹腔镜胆囊切除术中肺功能的适宜维持剂量为0.4μg·kg^-1·h^-1。Objective To evaluate the effect of different doses of dexmedetomidine on the lung injury during laparoscopic gallbladder surgery in elderly patients with mild obstructive ventilation dysfunction.Methods One hundred and twenty patients of both sexes,aged 65-75 yr,with body mass index of 18.5-23.9 kg/m^2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,who were diagnosed with mild obstructive ventilation dysfunction during the preoperative pulmonary function test,scheduled for elective laparoscopic gallbladder surgery under general anesthesia,were divided into 4 groups(n=30 each)using a random number table method:control group(group C)and different doses of dexmedetomidine groups(Dex1,Dex2 and Dex3 groups).In Dex1,Dex2 and Dex3 groups,dexmedetomidine was intravenously infused as a bolus of 1μg/kg over 10 min,followed by an infusion of 0.2,0.4 and 0.6μg·kg^-1·h^-1 until the end of operation,respectively.The equal volume of normal saline was given instead in group C.Airway peak pressure(Ppeak),mean airway pressure(Pmean),airway plateau pressure(Pplat),and positive end-expiratory pressure were measured immediately before pneumoperitoneum(T1),at the end of pneumoperitoneum(T2),and 10 min after the end of pneumoperitoneum(T3),and driving pressure was calculated.Arterial blood samples were obtained to record PaO2 and PaCO2,and oxygenation index(OI),respiratory index(RI),physiologic dead space fraction(VD/VT)and alveolar-arterial oxygen difference(A-aDO2)were calculated.The extubation time and development of complications such as hypercapnia and hypoxemia within 48 h after operation were recorded.Results Compared with group C,Ppeak,Pmean and driving pressure were significantly decreased,OI was increased,and the RI,VD/VT and A-aDO2 were decreased at T1-3,the intraoperative consumption of norepinephrine and atropine was increased,the extubation time was shortened,and the incidence of hyoxemia was decreased after operation in Dex1,Dex2 and Dex3 groups(P<0.05).Compared with group Dex1,Ppeak,Pmean and d

关 键 词：右美托咪啶 腹腔镜检查 呼吸功能试验 老年人 

分 类 号：R614[医药卫生—麻醉学]