天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (5): 602-604.doi: 10.11958/20150308

• 临床研究 • 上一篇    下一篇

不同剂量右美托咪定对单肺通气患者脑氧饱和度及 肺内分流的影响

孟昀 1， 张华 1， 夏智群 2， 于泳浩 2△， 宋春华 3   

  1. 1天津市天津医院麻醉科 （邮编300211）； 2天津医科大学总医院； 3天津经济技术开发区卫生防病站
  • 收稿日期:2015-11-11 修回日期:2015-12-21 出版日期:2016-05-15 发布日期:2016-05-18
  • 通讯作者: △通讯作者 E-mail:yuyonghao@126.com E-mail:my1129@sina.com
  • 作者简介:孟昀 （1981）， 女， 主治医师， 主要从事骨科及其他外科手术麻醉方面研究
  • 基金资助:
    1天津市天津医院麻醉科 （邮编300211）； 2天津医科大学总医院； 3天津经济技术开发区卫生防病站

Effects of different doses of dexmedetomidine on cerebral oxygen saturation and pulmonary#br# shunt fraction in patients undergoing one-lung ventilation#br#

MENG Yun1， ZHANG Hua1， XIA Zhiqun2， YU Yonghao2△， SONG Chunhua3   

  1. 1 Departmen of Anesthesiology, Tianjin Hospital, Tianjin 300211, China; 2 Tianjin Medical University General Hospital; 3 Center for Disease of Prevention and Control of TEDA
  • Received:2015-11-11 Revised:2015-12-21 Published:2016-05-15 Online:2016-05-18
  • Contact: △Corresponding Author E-mail:yuyonghao@126.com E-mail:my1129@sina.com

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摘要： 摘要： 目的 研究右美托咪定对单肺通气患者脑氧饱和度 （SctO2） 及肺内分流 （Qs/Qt） 的影响。方法 选取 60 例 行开胸手术患者， 年龄 46～71 岁， 体质指数 （BMI） 18～24 kg/m2， ASA 分级Ⅰ～Ⅱ级， 随机分为 3 组 （n=20）： 右美托咪 定高剂量组 （D1 组）、 右美托咪定低剂量组 （D2 组）、 对照组 （C 组）。麻醉诱导后 D1 组 10 min 泵注右美托咪定 1 μg/kg， 并按 0.5 μg·kg-1·h-1持续泵注； D2 组 10 min 泵注右美托咪定 0.5 μg/kg， 并按 0.3 μg·kg-1·h-1持续泵注； C 组给予等量生 理盐水。术中丙泊酚-瑞芬太尼维持全身麻醉， 间断追加罗库溴铵。于麻醉诱导前 （T0）、 双肺通气 15 min （T1）、 单肺通气 5 min （T2）、 单肺通气 30 min （T3） 时采集动脉血， 颈内静脉血进行血气分析， 计算 Qs/Qt， 并记录相应时间点的 SctO2。结 果 Qs/Qt 在 T2 时 D1 组低于 C 组、 D2 组， 在 T3 时 D1 组和 D2 组均低于 C 组， 且 D1 组低于 D2 组 （P < 0.05）。与 T0、 T1 时比较， C 组和 D1 组患者 SctO2在 T2、 T3 时均降低 （P < 0.05）； D2 组 SctO2在 T2、 T3 时较 C 组、 D1 组明显增高 （P < 0.05）。结论 右美托咪定可改善开胸手术患者单肺通气期间的氧合， 降低 Qs/Qt， 减少 SctO2下降。

关键词: 单肺通气, 右美托咪定, 脑氧饱和度, 肺内分流

Abstract: Abstract:Objective To investigate the effects of different doses of dexmedetomidine on cerebral oxygen saturation and pulmonary shunt fraction in patients undergoing one-lung ventilation (OLV). Methods Sixty ASAⅠ-Ⅱ patients, aged 46- 71 years, with body mass index (BMI)18- 24 kg/m2 and scheduled for thoracotomy were randomly divided into three groups (n=20 each):high dose dexmedetomidine group (group D1), low dose dexmedetomidine group (group D2) and control group (group C). Dexmedetomidine 1 μg/kg was infused in group D1 after anesthesia induction, and then a rate of 0.5 μg·kg-1·h-1 was continuously infused. Dexmedetomidine 0.5 μg/kg was infused in group D2 after anesthesia induction, and then a rate of 0.3 μg·kg-1·h-1 was continuously infused. Group C was received the equal volume of normal saline. Anesthesia was main⁃ tained with propofol-remifentanil and intermittent iv boluses of rocuronium. Arterial and jugular venous blood samples were collected before anesthesia induction (T0), at 15 min after two-lung ventilation (T1), at 5 min (T2) and 30 min (T3) of OLV for blood gas analysis. Value of Qs/Qt was calculated and SctO2 was recorded at the same time. Results Compared with group C and group D2, Qs/Qt was decreased at T2 in group D1 (P < 0.05). Qs/Qt was lower at T3 in group D1 and D2 than that of group C, and which was lower in group D1 than that of group D2 (P < 0.05). In group C and group D1 a significant de⁃ crease in SctO2 was observed at T2 and T3 compared to that at T0 and T1 (P < 0.05). SctO2 was significantly higher at T2 and T3 in group D2 than that in group C and group D1 (P < 0.05). Conclusion Dexmedetomidine given during OLV undergoing thoracotomy can improve oxygenation, decrease pulmonary shunt fraction and reduce the occurrence of low SctO2

Key words: one-lung ventilation, Dexmedetomidine, cerebral oxygen saturation, pulmonary shunt fraction