右美托咪定对老年胃癌根治术患者呼吸功能的影响被引量：7

Effects of dexmedetomidine on respiration function in elderly patients underwent radical gastrectomy

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摘要目的观察右美托咪定对接受胃癌根治术的老年患者呼吸功能的影响。方法选择全身麻醉下行胃癌根治术的老年患者40例，随机分为观察组（D组）和对照组（c组），每组20例。D组诱导前静脉泵入右美托咪定负荷量0．2μg／kg，输注时间15min，插管后以0．4μg/（kg·h）的速率泵注，术毕前30min停药。C组给予等容量氯化钠注射液。分别于使用右美托咪定前（T0）、手术开始后30min（T1）、术毕前30min（T2）、拔管前3min（T3）、术后12h（T4）和术后48h（T5）时采集桡动脉血样0．5ml，行动脉血气分析，测定动脉氧分压（PaO2）和动脉二氧化碳分压（PaCO2），并计算氧合指数（PaO2／FiO2）、肺泡一动脉血氧分压差（PA-a O2）以及呼吸指数（RI）。观察并记录T0-T5时间点的MAP和HR。观察记录拔管前的Riker镇静和躁动评分。结果与c组比较，在T3时点，D组Pa02／Fi02增高，PA-a O2、RI降低（P〈0．05）；在T4时点，D组PA-a O2仍低于C组（P〈0．05）。D组Riker镇静和躁动评分和躁动患者比例均明显降低（P〈0．05）。结论术中以0．4μg／（kg·h）的速率泵注右美托咪定可改善老年胃癌根治术患者苏醒期肺氧合作用，提高肺呼吸功能，降低患者苏醒期的躁动评分。 Objective To investigate the effects of dexmedetomidine on respiration function of elderly patients underwent radical gastrectomy. Methods Forty elderly patients underwent radical gastrectomy were randomly divided into control group （ group C ） and dexmedetomidine group （ group D ）. Twenty cases were included in each group. In group D, a loading dose of dexmedetomidine 0. 2 μg/kg was injected into the vein before anesthesia induction, and followed by the dose of 0. 4 μg/（kg· h）after anesthesia induction till 30 minutes before the end of operation, the equal volume saline was given in group C respectively. Blood samples were taken from radial artery before the injection of dexmedetomidine （T0）, 30 minutes after the beginning of operation （ T1 ）, 30 minutes before the end of operation （ T2 ）, 3 minutes before extubation（T3 ）, 12 hours after operation（T4） and 48 hours after operation（T5 ） to do arterial blood gas analysis. PaO2 and PaCO2 were recorded at each measuring point and calculate oxygenation index （ PaO2/FiO2 ）, alveolar-arterial difference （ PA- a O2 ） and respiratory index （ RI ）. Mean arterial pressure（MAP） and heart rate（HR） were recorded at T0 - T5 time points. Riker sedation - agitation scale scores were evaluated at extubation. Results Compared with group C, at T3 point, PaO2/FiO2 increased in group D（P 〈0. 05） ; PA-a O2 and RI decreased in group D（P 〈0. 05）. PA-a O2 at T4 point was also lower in group D than that in group C （P 〈 0. 05 ）. Riker sedation-agitation scale scores in group D was lower than that in group C （P 〈 0. 05）. Conclusions Intraoperative use of dexmedetomidine at the dose of 0. 4 μg/（kg· h） can improve oxygenation and respiration function of elderly patients underwent radical gastrectomy in anesthesia recovery period, and decrease riker sedation-agitation scale scores.

作者李军利艾艳秋

机构地区郑州大学第一附属医院麻醉科

出处《中国实用医刊》 2016年第20期40-43,共4页 Chinese Journal of Practical Medicine

关键词右美托咪定老年患者胃癌根治术呼吸功能 Dexmedetomidine Elderly Radical gastrectomy Respiration function

分类号 R614 [医药卫生—麻醉学] R735.2 [医药卫生—肿瘤]

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1魏利娟,许波,贾可源.老年患者腹部手术与麻醉相关肺部感染病原学分析与控制[J].中华医院感染学杂志,2014,24(4):953-955. 被引量：15
2Kang SH, Kim YS, Hong TH, et al. Effects of dexmedetomidine on in- flammatory responses in patients undergoing laparoscopic cholecystecto- my[J]. Acta Anaesthesiologiea Scandinavica, 2013,57(4) :480-487.
3Hanci V,Yurdakan G, Yurtlu S,et al. Protective effect of dexmedetomi- dine in a rat model of a-naphthylthiourea-induced acute lung injury[J]. J Surg Res, 2012, 178(1) : 424-430.
4Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Seda- tion-Agitation Scale for adult critically ill patients [ J]. Critical Care Medicine, 1999, 27 (7) : 1325-1329.
5Marcos F, Melo V,Eikermann M. Protect the lungs during abdominal surgery:it may change the postoperative outcome[J~. Anesthesiology, 2013,118(6) :1254-1257.
6ARDS Definition Task Force, Raniefi VM, Rubenfeld GD, et al. Acuterespiratory distress syndrome: The Berlin Definition [ J ]. JAMA, 2012,307 (23) :2526-2533.
7Yamakage M, Iwasaki S, Satoh JI, et al. Inhibitory effects of the al- pha-2 adrenergie agonists elonidine and dexmedetomidine on enhanced airway tone in ovalbumin-sensitized guinea pigs [ J ]. Eur J Anaesthesiol, 2008,25 ( 1 ) : 67-71.
8Nakatani H, Kim C, Sakamoto A. Low-dose dexmedetomidine facili- tates the carotid body response to low oxygen tension in vitro via oL2- adrenergie receptor activation in rabbits [ J ]. Eur J Anaesthesiol, 2012, 29(12) :570-576.
9kim SY, Kim JM, Lee JH, et al. Efficacy of intraoperative dexmedeto- midine infusion on emergence agitation and quality of recovery after nasal surgery[J]. Br J Anaesth, 2013,111 (2) :222-228.
10Dong Jun Kim, Sang Hun Kim, Keum Young So, et al. Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly pa- tients undergoing orthopaedic surgery [ J ]. BMC Anesthesiology, 2015,15(1) :1-11.