不同剂量右美托咪定在老年手术患者中的效果  

The Effect of Different Doses of Dexmedetomidine in Elderly Surgical Patients

作　　者：李博 李保华 李晓国 LI Bo;LI Baohua;LI Xiaoguo(Department of anesthesiology,Henan No.2 Provincial People’s Hospital,Zhengzhou Henan 451100,China)

机构地区：[1]河南省第二人民医院麻醉科,河南郑州451100

出　　处：《临床研究》2024年第6期103-106,共4页Clinical Research

摘　　要：目的探讨腹腔镜胆囊切除术(LC)伴阻塞性通气功能障碍老年患者肺功能与右美托咪定剂量的相关性。方法按随机数字表法将河南省第二人民医院2020年9月至2023年3月收治的126例LC伴阻塞性通气功能障碍老年患者分为A组(右美托咪定剂量为0.2μg·kg^(-1)·h^(-1)),B组(右美托咪定剂量为0.4μg·kg^(-1)·h^(-1)),C组(右美托咪定剂量为0.6μg·kg^(-1)·h^(-1)),每组42例。比较三组患者不同时间[气腹建立后即刻(T_(1))、结束气腹前(T_(2))和结束气腹后10 min(T_(3))时]平均气道压(Pmean)、气道平台压(Pplat)、气道峰压(Ppeak)、驱动压,血气分析指标以及拔管时间和并发症情况。结果B组T_(1)、T_(2)、T_(3)时Pmean、Pplat、Ppeak和驱动压低于A组和C组,差异均有统计学意义(P<0.05),A组、C组组间比较差异无统计学意义(P>0.05);B组T_(1)、T_(2)、T_(3)时氧合指数(OI)高于A组和C组,差异均有统计学意义(P<0.05);B组呼吸指数(RI)、死腔通气率(VD/VT)和肺泡-动脉血氧分压差(A-aDO2)低于A组和C组,差异均有统计学意义(P<0.05),A组、C组比较差异无统计学意义(P>0.05);B组拔管时间短于A组和C组,差异均有统计学意义(P<0.05),A组、C组比较差异无统计学意义(P>0.05);三组术后高碳酸血症(PHY)、低氧血症等并发症发生率比较差异无统计学意义(P>0.05)。结论右美托咪定维持剂量0.4μg·kg^(-1)·h^(-1)对LC伴阻塞性通气功能障碍的老年患者气道压力、血气分析指标的影响低于0.2μg·kg^(-1)·h^(-1)及0.6μg·kg^(-1)·h^(-1),并可缩短术后拔管时间,且不增加患者术后并发症发生风险。Objective To explore the correlation between lung function and dexmedetomidine dose in elderly patients with laparoscopic cholecystectomy(LC)with obstructive ventilation dysfunction.Methods The randomized numerical table method was employed to categorize 126 elderly patients with LC and obstructive ventilation dysfunction who were admitted to the Second People's Hospital of Henan Province between September 2020 and March 2023.These patients were divided into three groups:Group A(dexmedetomidine dose of 0.2μg/kg),Group B(dexmedetomidine dose of 0.4μg/kg),and Group C(dexmedetomidine dose of 0.6μg/kg).A total of 42 cases were included in each group.The mean airway pressure(Pmean),airway plateau pressure(Pplat),airway peak pressure(Ppeak),driving pressure,blood gas analysis indexes,as well as extubation time and complications were compared among the patients in the three groups at different times:immediately after the establishment of the pneumoperitoneum(T_(1)),before the end of the pneumoperitoneum(T_(2)),and at 10 min after the end of the pneumoperitoneum(T_(3)).Results The Pmean,Pplat,Ppeak,and driving pressure at T_(1),T_(2),and T_(3) in group B were found to be lower than those in groups A and C.These differences were statistically significant(P<0.05),whereas the differences between groups A and C were not statistically significant(P>0.05).Additionally,the oxygenation index(OI)was observed to be higher than that in groups A and C. At T_(1), T_(2), and T_(3) in group B, the differences were statistically significant (P < 0.05). The B respiratory index (RI), dead space ventilation rate (VD/VT), and alveolar-arterial oxygen partial pressure difference (A-aDO_(2)) were lower in group B than in groups A and C, and the differences were statistically significant (P < 0.05). The differences between groups A and C were not statistically significant when comparing groups A and C (P > 0.05). The time of extubation in group B was shorter than that in groups A and C, and the differences were statistically significant (P

关 键 词：腹腔镜胆囊切除术 阻塞性通气功能障碍 肺功能 右美托咪定 剂量 

分 类 号：R575.6[医药卫生—消化系统]