本文選題：右美托咪定 + 烏司他丁�。� 參考：《中國藥房》2017年35期

【摘要】：目的:觀察右美托咪定聯(lián)合烏司他丁對單肺通氣肺葉切除術患者應激反應指標、血管外肺水值(EVLW)和肺血管通透性指數(shù)(PVPI)等的影響。方法:選擇2015年11月-2016年11月在西南醫(yī)科大學附屬醫(yī)院行單肺通氣肺葉切除術的患者80例,按隨機數(shù)字表法分為對照組(N組)、烏司他丁預處理組(U組)、右美托咪定持續(xù)泵注組(D組)、烏司他丁預處理+右美托咪定持續(xù)泵注組(U+D組),各20例。全部患者在麻醉誘導前30 min,肌內(nèi)注射硫酸阿托品0.5 mg,局麻下行右側(cè)頸內(nèi)靜脈及同側(cè)股動脈穿刺置管。在此基礎上,N組患者靜脈滴注0.9%氯化鈉注射液100 m L;U組患者靜脈滴注含注射用烏司他丁20萬單位的氯化鈉混合溶液100 m L;D組患者按1μg/(kg·h)的劑量持續(xù)靜脈泵注2μg/m L的鹽酸右美托咪定注射液氯化鈉混合溶液,誘導結束后按0.5μg/(kg·h)的劑量靜脈泵注至手術結束;U+D組患者按上述靜脈途徑給予含烏司他丁20萬單位的氯化鈉混合溶液和4μg/m L的右美托咪定氯化鈉混合溶液各50 m L(誘導期及維持期劑量同前)。比較4組患者麻醉誘導前30 min(T1)、手術開始2 h(T2)、氣管拔管即刻(T3)和術后12 h(T4)的血糖、血氧分壓[p(O2)]、促腎上腺皮質(zhì)激素(ACTH)、去甲腎上腺素(NE)、心率(HR)、心輸出量(CO)、系統(tǒng)血管阻力(SVR)、EVLW和PVPI;記錄患者T2～T4時點的液體出入量。觀察4組患者不良反應發(fā)生情況。結果:4組患者T1時點的各項指標比較,差異均無統(tǒng)計學意義(P0.05)。T2～T4時點,N組患者的血糖、ACTH、NE、SVR、EVLW和PVPI均顯著高于其余3組,且U、D組顯著高于U+D組,差異均有統(tǒng)計學意義(P0.05),而U組和D組比較差異均無統(tǒng)計學意義(P0.05);U+D組患者的p(O2)和CO均顯著高于其余3組,差異均有統(tǒng)計學意義(P0.05),而其余3組患者之間比較差異均無統(tǒng)計學意義(P0.05);N、U組患者的HR顯著高于其余2組,差異均有統(tǒng)計學意義(P0.05),而N組與U組、D組與U+D組比較差異均無統(tǒng)計學意義(P0.05);4組患者的液體出入量比較,差異均無統(tǒng)計學意義(P0.05)。4組患者均未見明顯的不良反應發(fā)生。結論:右美托咪定聯(lián)合烏司他丁可明顯減輕OLV肺葉切除術患者的應激反應,降低EVLW和PVPI等部分血流及呼吸動力學指標,從而發(fā)揮肺保護效應。
[Abstract]:Aim: to observe the effects of dexmetomidine combined with ulinastatin on stress response, extravascular lung water value (EVLW) and pulmonary vascular permeability index (PVPI) in patients undergoing single lung ventilation lobectomy.Methods: from November 2015 to November 2016, 80 patients underwent single lung ventilation lobectomy in the affiliated Hospital of Southwest Medical University.According to the random digital table method, the rats were divided into control group (n group), ulinastatin preconditioning group (group U), dexmetomidine continuous pump group (group D) and ulinastatin preconditioning group (n = 20).All patients received intramuscular injection of atropine sulfate (0.5 mg) 30 minutes before anesthesia induction. Local anesthesia was performed on the right internal jugular vein and ipsilateral femoral artery catheterization.On the basis of this, the patients in group N received 0.9% sodium chloride injection 100ml / L intravenously, and patients in group A received intravenous infusion of 2 渭 g / mL of urinastatin 200000 units of sodium chloride mixed solution for injection at a dose of 1 渭 g/(kg / h.Dexmetomidine hydrochloride injection sodium chloride mixed solution,After induction (0.5 渭 g/(kg / h), the patients in the UD group received intravenous injection of urinastatin 200000 units of sodium chloride mixed solution and 4 渭 g / mL dexmetomidine sodium chloride mixture solution of 50 mL each (5 渭 g / mL).The dose in induction period and maintenance period was the same as that in prednisone.The blood glucose levels of the four groups were compared 30 min before anesthesia induction, 2 h after operation, 3 h after tracheal extubation (T3) and 12 h after T4).Blood oxygen partial pressure (PPO _ 2), adrenocorticotropic hormone (ACTH), norepinephrine (NE), heart rate (HRT), cardiac output (T2~T4), systemic vascular resistance (SVR), EVLW and PVPIwere recorded.Adverse reactions were observed in 4 groups.Results there was no significant difference in all the indexes at T1 time point between the two groups. The EVLW and PVPI of the N group were significantly higher than those of the other three groups, and the levels of EVLW and PVPI in the UD group were significantly higher than those in the UD group.The difference was statistically significant (P 0.05), but there was no significant difference between group U and group D (P 0.05) and CO in group D were significantly higher than those in the other three groups.The differences were statistically significant (P 0.05), but there was no significant difference among the other three groups. The HR of the patients in the P0.05 group was significantly higher than that in the other two groups.The difference was statistically significant (P 0.05), but there was no significant difference between N group and U group D group and U D group.Conclusion: dexmetomidine combined with ulinastatin can significantly reduce the stress response of patients with OLV lobectomy, decrease some hemodynamic indexes such as EVLW and PVPI, and thus play a protective role in lung protection.
【作者單位】： 西南醫(yī)科大學臨床醫(yī)學院;攀枝花學院附屬醫(yī)院麻醉科;
【基金】：四川省醫(yī)學科研青年創(chuàng)新課題計劃立項(No.Q15052)
【分類號】：R614

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