右美托咪定对体外循环下心脏瓣膜置换患者的肺保护作用  

Protective Effect of Dexmedetomidine on Pulmonary Function of Patients with Cardiac Valve Replacement Under Extracorporeal Circulation

作　　者：潘佳美 张黔 唐金清 张红 PAN Jiamei;ZHANG Qian;TANG Jinqing;ZHANG Hong(Department of Anesthesiology,Zunyi Medical University Affiliated Hospital,Zunyi,Guizhou 563000;Department of Cardiovascular Surgery,Zunyi Medical University Affiliated Hospital,Zunyi,Guizhou 563000;Department of Anesthesiology,Zunyi Medical University the Third Affiliated Hospital,Zunyi,Guizhou 563000)

机构地区：[1]遵义医科大学附属医院麻醉科,贵州遵义563000 [2]遵义医科大学附属医院心血管外科,贵州遵义563000 [3]遵义医科大学第三附属医院麻醉科,贵州遵义563000

出　　处：《智慧健康》2024年第30期61-63,67,共4页Smart Healthcare

基　　金：贵州省社会攻关计划《急性肺损伤病人肺保护的临床研究》(项目编号:黔科合SY字[2015]3050)。

摘　　要：目的探讨右美托咪定对体外循环下心脏瓣膜置换患者的肺保护作用。方法将2019年1月—2021年12月本院收治的68例体外循环下心脏瓣膜置换术患者随机分为两组,均采用全身麻醉,观察组在麻醉诱导前及麻醉中泵注右美托咪定,对照组在麻醉诱导前及麻醉中泵注等量生理盐水,对比两组不同时间点的炎症因子水平、呼吸参数、苏醒指标值。结果观察组术毕时(T_(2))、术后24h(T_(3))的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平均低于对照组(P<0.05);观察组锯胸骨时(T_(1)~T_(3))的氧合指数(OI)均高于对照组,呼吸指数(RI)均低于对照组(P<0.05);观察组苏醒时间、自主呼吸恢复时间、定向力恢复时间均短于对照组,肺部感染、急性肺损伤等发生率低于对照组(P<0.05)。结论右美托咪定在体外循环下心脏瓣膜置换术中有良好的肺保护作用,可有效减轻肺组织炎症反应,降低RI,提高OI,缩短术后苏醒时间,减少肺组织损伤。Objective To investigate pulmonary protective effect of dexmedetomidine for patients with cardiac valve replacement under extracorporeal circulation.Methods The paper chose 68 patients with cardiac valve replacement surgery under extracorporeal circulation in our hospital from January 2019 to December 2021,and divided them into two groups randomly,received general anesthesia.The observation group was treated with dexmedetomidine infusion before and during anesthesia,while the control group with equal amount of saline infusion before and during anesthesia.Inflammatory factors,respiratory parameters,and recovery indicators were compared between two groups at different time points.Results The levels of IL-6,IL-8,and TNF-αin observation groups at T_(2) and T_(3) were lower than the control group(P<0.05).The OI of observation groups at T_(1)-T_(3) was higher than the control group,while the RI was lower than the control group(P<0.05).The observation group had shorter awakening time,autonomous breathing recovery time,and orientation recovery time than the control group,incidence of lung infections,acute lung injuries,and other conditions were lower than the control group(P<0.05).Conclusion Dexmedetomidine can achieve good pulmonary protective effect on cardiac valve replacement surgery under extracorporeal circulation,can reduce lung tissue inflammation,lower RI,improve OI,shorten postoperative recovery time,and reduce lung tissue damage effectively.

关 键 词：体外循环 心脏瓣膜置换术 右美托咪定 肺保护 

分 类 号：R65[医药卫生—外科学]