肺保护性通气策略下右美托咪定对腹腔内热灌注化疗患者肺功能的影响  

Effect of Dexmedetomidine on lung function in patients with intraperitoneal heat perfusion chemotherapy under pulmonary protective ventilation strategy

作　　者：龚建平 梁秀生[1] 刘玉妍 李燕旋 邵兵[1] 李恒[1] GONG Jianping;LIANG Xiusheng;LIU Yuyan;LI Yanxuan;SHAO Bing;LI Heng(Department of Anesthesiology,the Sixth Affiliated Hospital of Guangzhou Medical University,Qingyuan People's Hospital,Guangdong Province,Qingyuan 511500,China)

机构地区：[1]广州医科大学附属第六医院广东省清远市人民医院麻醉科,广东清远511500

出　　处：《中国当代医药》2022年第32期149-154,共6页China Modern Medicine

基　　金：广东省清远市科技计划项目(2020KJJH017)。

摘　　要：目的探讨右美托咪定联合肺保护性通气对腹腔内热灌注化疗患者呼吸力学及肺功能的影响。方法选取2021年1月至2022年1月于清远市人民医院择期行腹腔内热灌注化疗的75例患者作为研究对象,按照随机数字表法将其分为常规组(37例)和联合组(38例)。常规组患者采用常规麻醉和常规双肺通气,联合组患者在常规组的基础上采用右美托咪定麻醉联合肺保护性通气策略通气。比较两组患者热灌注化疗即刻(T_(1))、热灌注化疗30 min(T_(2))、热灌注化疗60 min(T_(3))、拔管前(T_(4))的血清肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6)含量、呼吸力学、肺功能指标及肺部并发症发生情况。结果两组患者T_(2)、T_(3)、T_(4)时刻的TNF-α、IL-6水平均高于同组T_(1)时刻,差异有统计学意义(P<0.05);联合组患者T_(2)、T_(3)、T_(4)时刻的TNF-α、IL-6水平低于常规组,差异有统计学意义(P<0.05)。两组患者T_(2)、T_(3)时刻的气道峰压(P_(peak))、气道平台压(P_(plat))和气道阻力(R_(aw))高于同组T_(1)时刻,差异有统计学意义(P<0.05);常规组患者T_(4)时刻P_(peak)、P_(plat)、R_(aw)高于本组T_(1)时刻,差异有统计学意义(P<0.05);联合组患者T_(2)、T_(3)、T_(4)时刻的P_(peak)、P_(plat)、R_(aw)低于常规组,差异有统计学意义(P<0.05)。两组患者T_(2)、T_(3)时刻的肺泡动脉氧分压差(A-aDO_(2))、呼吸指数(RI)、死腔率(V_(D)/V_(T均))高于同组T_(1)时刻,氧合指数(OI)低于同组T_(1)时刻,差异有统计学意义(P<0.05);联合组患者T_(2)、T_(3)时刻的A-aDO_(2)、RI、V_(D)/V_(T均)低于常规组,OI高于常规组,差异有统计学意义(P<0.05)。两组患者各时刻的二氧化碳分压(PaCO_(2))比较,差异无统计学意义(P>0.05)。联合组患者的肺部并发症总发生率低于常规组,差异有统计学意义(P<0.05)。结论腹腔内热灌注化疗患者采用右美托咪啶联合肺保护性通气可以有效改善患者呼吸功能,减少�Objective To investigate the effect of Dexmedetomidine combined with lung protective ventilation on respiratory mechanics and lung function in patients with intraperitoneal heat perfusion chemotherapy.Methods A total of 75 patients who underwent elective intraperitoneal hyperthermic infusion chemotherapy in Qingyuan People's Hospital from January 2021 to January 2022 were selected as the research objects.According to the random number table method,they were divided into conventional group(37 cases)and combined group(38 cases).Patients in the conventional group received conventional anesthesia and conventional two-lung ventilation,while patients in the combined group received Dexmedetomidine anesthesia combined with lung protective ventilation strategy on the basis of the conventional group.The levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),respiratory mechanics,pulmonary function indexes and the incidence of pulmonary complications were compared between the two groups immediately(T_(1)),30 min(T_(2)),60 min(T_(3))and before extubation(T_(4)).Results The levels of TNF-αand IL-6 at T_(2),T_(3) and T_(4) in the two groups were higher than those at T_(1) in the same group,and the differences were statistically significant(P<0.05).The levels of TNF-αand IL-6 at T_(2),T_(3) and T_(4) in the combined group were lower than those in the conventional group,and the differences were statistically significant(P<0.05).The peak airway pressure(P_(peak)),plateau airway pressure(P_(plat))and airway resistance(R_(aw))at T_(2) and T_(3) in the two groups were higher than those at T_(1) in the same group,and the differences were statistically significant(P<0.05).P_(peak),P_(plat) and R_(aw) at T_(4) in the conventional group were higher than those at T_(1) in the control group,and the differences were statistically significant(P<0.05).P_(peak),P_(plat) and R_(aw) at T_(2),T_(3) and T_(4) in the combined group were lower than those in the conventional group,and the differences were statistically significant(P<

关 键 词：腹腔内热灌注化疗 右美托咪定 肺保护性通气 呼吸力学 肺功能 

分 类 号：R614.2[医药卫生—麻醉学]