右美托咪定对慢性吸烟患者腹腔镜手术的肺保护作用
Protective Effect of Dexmedetomidine on Pulmonary Function in Smoking Patients Undergoing Laparoscopic Surgery
DOI: 10.12677/ACM.2021.118560, PDF,   
作者: 张楠楠, 施彩凤, 江亚楠, 苏颖颖, 荆天玉, 温翠丽*：青岛大学附属医院麻醉科，山东 青岛
关键词: 右美托咪定；吸烟；肺保护；全身麻醉；Dexmedetomidine； Smoking； Lung Protection； Anesthesia
摘要: 目的：比较不同剂量右美托咪定对慢性吸烟患者行腹腔镜手术术中、术后呼吸功能的影响。方法：选择普外科择期拟行腹腔镜手术的慢性吸烟患者60例，随机分为3组，0.5 ug∙kg−1右美托咪定组(D1)和1.0 ug∙kg−1右美托咪定组(D2)在诱导前分别泵注相应剂量的右美托咪定，空白对照组(D0)泵注相同体积生理盐水。麻醉诱导完毕后泵注相应浓度及速度的试验药物，分别于麻醉诱导后(T0)、气腹60 min (T1)、气腹120 min (T2)、气腹结束(T3)、术后6 h (T4)、术后24 h (T5)、术后48 h (T6)抽取桡动脉血2 ml行血气分析，计算氧合指数(OI)、呼吸指数(RI)。计算T0~T3时间点的肺动态顺应性(Cdyn)。记录手术时间、出入量、苏醒时间，随访术后肺部并发症(PPCS)发生情况和住院时间。结果：由于低血压反复使用血管活性药物、及腹腔镜中转为开腹手术，D0及D1组均有一例患者被排除在研究之外。D0组患者在气腹过程中OI逐渐降低、RI逐渐增加(p < 0.05)，D1、D2组患者气腹过程中及术后较术前OI增加、RI降低(p＜0.05)。组间对比，与DO组比较，D1、D2组在气腹过程中及术后氧合指数(OI)增加、呼吸指数(RI)降低(p < 0.05)，与D1组比较，D2组患者术后呼吸指数(RI)降低(p < 0.05)。D1组、D2组术后发生低氧血症患者明显少于D0组(p < 0.05)，D2组苏醒时间显著延长(p < 0.05)。结论：0.5 μg∙kg−1、1.0 μg∙kg−1的右美托咪定均能有效改善慢性吸烟患者气腹手术的呼吸水平，进而改善肺功能，而1.0 μg∙kg−1的右美托咪定会延长患者苏醒时间。
Abstract: Objective: To evaluate the effects of different doses of dexmedetomidine on respiration function during and after laparoscopic surgery in chronic smoking patients. Methods: Sixty chronic smokers who were scheduled to undergo laparoscopic surgery in general surgery were randomly divided into 3 groups. 0.5 ug∙kg−1 dexmedetomidine group (D1) and 1.0 ug∙kg−1 dexmedetomidine group (D2) were injected with corresponding doses, Control group (D0) was injected with the same volume of saline to pump the experimental drugs with the corresponding concentration and speed after the induction of anesthesia. 2 ml of radial artery blood was extracted for blood gas analysis, and calculation of oxygenation index (OI), Respiratory index (RI) respectively after induction of anesthesia (T0), 60 minutes of pneumoperitoneum (T1), 120 minutes of pneumoperitoneum (T2), end of pneumoperitoneum (T3), 6 h after operation (T4), 24 h after operation (T5), 48 h after operation (T6). The lung dynamic compliance (Cdyn) at T0~T3 time points is calculated. Operation time, intake and output, recovery time, follow-up postoperative pulmonary complications (PPCS) occurrence and hospital stay are recorded. Results: Due to the repeated use of vasoactive drugs for hypotension and laparoscopic conversion to open surgery, one patient in each of the D0 and D1 groups was excluded from the study. In Group D0, OI gradually decreased and RI gradually increased during the pneumoperitoneum (p < 0.05). During and after the pneumoperitoneum in the D1 and D2 groups, OI increased and RI decreased compared with preoperative (p < 0.05). Compared with the DO group, the oxygenation index (OI) increased during and postoperative pneumoperitoneum, respiratory index (RI) decreased in D1 and D2 groups (p < 0.05). Compared with the D1 group, the postoperative respiratory index (RI) was lower in D2 group (p < 0.05). patients with postoperative hypoxemia in D1 and D2 groups were significantly less than those in D0 group (p < 0.05), and the recovery time in D2 group was significantly prolonged (p < 0.05). 0.5 μg∙kg−1 and 1.0 μg∙kg−1 dexmedetomidine can effectively improve the breathing level of pneumoperitoneum surgery in chronic smoking patients, thereby improving lung function,but 1.0 μg∙kg−1 dexmedetomidine prolongs the patient’s recovery time.
文章引用：张楠楠, 施彩凤, 江亚楠, 苏颖颖, 荆天玉, 温翠丽. 右美托咪定对慢性吸烟患者腹腔镜手术的肺保护作用[J]. 临床医学进展, 2021, 11(8): 3813-3819. https://doi.org/10.12677/ACM.2021.118560

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