右美托咪定对老年患者全身麻醉诱导期上腔静脉血氧饱和度的影响  

Effect of dexmedetomidine on oxygen saturation of superior vena cava during induction of general anesthesia in elderly patients

作　　者：费建平[1] 冯树全 俞灵 雷月[1] 孙贺斌 包华芳[1] 袁春英[1] FEI Jian-ping;FENG Shu-quan;YU Ling(Department of Anesthesiology,Kunshan Hospital of traditional Chinese medicine,Kunshan 215300,China)

机构地区：[1]昆山市中医医院麻醉科,江苏昆山215300

出　　处：《吉林医学》2021年第10期2381-2385,共5页Jilin Medical Journal

基　　金：2019年昆山市重点研发计划(社会发展专项指令性项目)[项目编号:KS1954]。

摘　　要：目的:探讨麻醉诱导期上腔静脉血氧饱和度改变的一般规律以及右美托咪定对上腔静脉血氧饱和度的影响。方法:择期手术患者90例,ASA分级Ⅰ~Ⅱ级,年龄49~75岁,随机分为气管插管组(Q组,n=30)、喉罩通气组(H组,n=30)和试验组(D组,Dex预处理+喉罩,n=30),D组以3.2μg/(kg·h)的速率微泵注射右美托咪定(Dex)12 min(负荷量:0.8μg/kg),以1.6μg/(kg·h)的速率持续泵注至气管插管后20 min,以0.4μg/(kg·h)速率持续泵注至术毕;Q组、H组诱导前12 min注射咪达唑仑0.5~1.0 mg,泵注等量生理盐水。分别在中心静脉穿刺后(T_(0))、气管插管后5 min(T_(1))、15 min(T_(2))、20 min(T_(3))、术中(T_(4))采集动脉血气分析与上腔静脉血气分析,观察各时间点患者上腔静脉血氧分压(PcvO_(2))、氧饱和度(ScvO_(2))、二氧化碳分压(PcvCO_(2))和上腔静脉血pH值(PHcv)、乳酸(Hlacv)、血糖(Gluv)改变。结果:气管(喉罩)插管后,三组患者PcvO_(2)、ScvO_(2)均表现为快速上升然后缓慢下降的趋势,与T_(1)比较,T_(2)、T_(3)时Q组PcvO_(2)、ScvO_(2)下降,差异有统计学意义(P<0.05)。T_(1)~T_(3)PcvO_(2)、ScvO_(2)由高到低排序为Q组>H组>D组,D组PcvO_(2)、ScvO_(2)低于Q组和H组,差异有统计学意义(P<0.01),T_(1)时H组PcvO_(2)和ScvO_(2)低于Q组,差异有统计学意义(P<0.05)。T_(1)~T_(4),与Q组、H组比较,D组PcvCO_(2)升高,差异有统计学意义(P<0.05)。结论:气管插管或喉罩插入后PcvO_(2)、ScvO_(2)呈现快速上升然后缓慢下降的趋势,反映了全身血流再分布改变;持续泵注右美托咪定能够有效缓解麻醉诱导期全身血流再分布改变,有利于维持脑氧耗需平衡。Objective To explore the general rule of the oxygen saturation of the superior vena cava during anesthesia induction and the effect of dexmedetomidine on the oxygen saturation of the superior vena cava.Method 90 ASA gradeⅠ~Ⅱpatients aged 49~75 years were randomly divided into three groups:tracheal intubation group(group Q,n=30),laryngeal mask ventilation group(group H,n=30)and experimental group(group D,DEX pretreatment+laryngeal mask,n=30),In group D,0.8μg/kg DEX was continuously pumped for 12 minutes before anesthesia induction,and then at the rate of 1.6μg/(kg·h)DEX was continuously pumped for 20 minutes after intubation,and continuously pumped at the rate of 0.4μg/(kg·h)until the end of operation.Midazolam 0.5~1.0 mg was injected 12 minutes before anesthesia induction in group Q and group H,then the same amount of normal saline was pumped.Arterial blood gas analysis and superior vena cava blood gas analysis were collected at T_(0)(just after central vein puncture),T_(1)(5 minutesafter intubation),T_(2)(15 minutes after intubation),T_(3)(20 minutes after intubation),T_(4)(intraoperative)respectively.The central venous oxygen partial pressure(PcvO_(2)),central venous oxygen saturation(ScvO_(2)),central venouscarbon dioxide partial pressure(PcvCO_(2))were compared at each time point and the differences of pH value(PHcv),lactate(Hlacv),blood glucose(Gluv)in central venous blood were observed too.Results After intubation of tracheal(or laryngeal mask),PcvO_(2)and ScvO_(2)in all the groups showed a rapid rise and then a slow decline trend.Compared with T_(1),the decline of PcvO_(2)and ScvO_(2)in group Q was statistically significant at T_(2)and T_(3)(P<0.05).The order of PcvO_(2)and ScvO_(2)in T_(1)~T_(3)was group Q>group H>group D.PcvO_(2)and ScvO_(2)in D group were lower than those in group Q and group H(P<0.01).PcvO_(2)and ScvO_(2)in group H were lower than those ingroupQat T_(1)(P<0.05).Compared with group Q and group H,the increase of PcvCO_(2)in group D was statistically significant at T_(1)~T_(4)(P<

关 键 词：右美托咪定 上腔静脉血氧饱和度 颈静脉球血氧饱和度 脑氧摄取率 

分 类 号：R614.2[医药卫生—麻醉学]