本文選題：右美托咪定　切入點：單肺通氣　出處：《臨床麻醉學(xué)雜志》2017年11期

【摘要】：目的探討右美托咪定對單肺通氣(OLV)患者動脈血氣和炎性因子的影響。方法選擇擇期肺癌根治術(shù)患者62例,性別不限,年齡34~69歲,ASAⅠ或Ⅱ級。按照收治先后順序分成觀察組和對照組,每組31例。所有患者靜脈注射舒芬太尼0.3~0.5μg/kg、丙泊酚1.5~2.5mg/kg、咪達(dá)唑侖0.5 mg/kg、羅庫溴銨0.9 mg/kg行麻醉誘導(dǎo);靜脈輸注丙泊酚6~8 mg·kg~(-1)·h~(-1)、瑞芬太尼0.1~0.5μg·kg~(-1)·min~(-1),間斷靜脈注射順式阿曲庫銨進(jìn)行麻醉維持。觀察組患者于麻醉誘導(dǎo)前10min靜脈輸注右美托咪定1.0g/kg,10min輸注完,之后維持0.5μg·kg~(-1)·h~(-1)速率輸注至手術(shù)結(jié)束前30min。對照組則輸注等量的生理鹽水。分別于OLV前即刻(T0)、OLV 1h后(T1)、OLV結(jié)束時(T2)采集橈動脈血,檢測血氣(pH、PaO_2、PaCO_2)和炎性因子(TNF-α和IL-6)。記錄兩組手術(shù)結(jié)束后丙泊酚用量。結(jié)果與T0時比較,T1、T2時兩組pH、PaO_2明顯降低,PaCO_2明顯升高,TNF-α和IL-6含量明顯升高(P0.05);T1、T2時觀察組PaO_2明顯高于對照組(P0.05),PaCO_2明顯低于對照組(P0.05),TNF-α和IL-6含量明顯低于對照組(P0.05)。兩組圍術(shù)期順式阿曲庫銨用量和瑞芬太尼用量差異無統(tǒng)計學(xué)意義,觀察組丙泊酚用量明顯低于對照組(P0.05)。結(jié)論右美托咪定有助于維持單肺通氣患者術(shù)中血氣穩(wěn)定,減輕單肺通氣引起的炎癥反應(yīng)。
[Abstract]:Objective to investigate the effects of dexmetomidine on arterial blood gas and inflammatory factors in patients with single lung ventilation (OLVV). The patients were divided into observation group (n = 31) and control group (n = 31). All patients received intravenous injection of sufentanil (0.3 渭 g / kg), propofol (1.5 mg / kg), midazolam (0.5 mg / kg), rocuronium (0.9 mg / kg). Intravenous infusion of propofol (6mg / kg) -1) and remifentanil (0.1 ~ 0.5 渭 g / kg ~ (-1)) 路min ~ (-1) / min were maintained by intermittent intravenous injection of cis-atracurium. The patients in the observation group were given dexmetomidine 1.0 g / kg / kg for 10 minutes before anesthesia induction, and the patients in the observation group were given dexmetoimidine (1.0 g / kg) 10 minutes before anesthesia induction, and the patients in the observation group were given intravenous infusion of dexmetomidine (1.0 g / kg) for 10 minutes. The radial artery blood was collected at 0.5 渭 g 路kg ~ (-1) 路h ~ (-1) 路h ~ (-1)) and 30 min before operation. The control group was given the same amount of normal saline. The radial artery blood was collected at the end of T _ (1) and T _ (1) T _ (1) and T _ (2) at the end of OLV immediately before OLV. The levels of propofol in two groups after operation were recorded. Results compared with T _ 1 T _ 2 group, the pH Pao _ 2 of two groups significantly decreased and the content of Paco _ 2 and IL-6 increased significantly. The PaO_2 of observation group was significantly higher than that of control group at the end of operation (P _ (0.05)) and T _ (1) T _ (2), compared with that at T _ (1) T _ (2), P0. 05% T _ (1) T _ (2) was significantly higher in observation group than in control group (P < 0. 05). The contents of TNF- 偽 and IL-6 in group P0.05 were significantly lower than those in control group. There was no significant difference in the dosage of cis atracurium and remifentanil between the two groups during perioperative period. Conclusion the dosage of propofol in the observation group is significantly lower than that in the control group (P 0.05). Conclusion dexmetomidine is helpful to maintain blood gas stability in patients with single lung ventilation and to alleviate the inflammatory reaction induced by single lung ventilation.
【作者單位】： 江蘇省靖江市人民醫(yī)院麻醉科;
【分類號】：R614

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