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右美托咪定联合乌司他丁对单肺通气肺叶切除术患者应激反应指标等的影响
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| 篇名： | 右美托咪定联合乌司他丁对单肺通气肺叶切除术患者应激反应指标等的影响 |
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| 摘要： | 目的：观察右美托咪定联合乌司他丁对单肺通气肺叶切除术患者应激反应指标、血管外肺水值（EVLW）和肺血管通透性指数（PVPI）等的影响。方法：选择2015年11月－2016年11月在西南医科大学附属医院行单肺通气肺叶切除术的患者80例，按随机数字表法分为对照组（N组）、乌司他丁预处理组（U组）、右美托咪定持续泵注组（D组）、乌司他丁预处理+右美托咪定持续泵注组（U+D组），各20例。全部患者在麻醉诱导前30 min，肌内注射硫酸阿托品0.5 mg，局麻下行右侧颈内静脉及同侧股动脉穿刺置管。在此基础上，N组患者静脉滴注0.9％氯化钠注射液100 mL；U组患者静脉滴注含注射用乌司他丁20万单位的氯化钠混合溶液100 mL；D组患者按1 μg/（kg·h）的剂量持续静脉泵注2 μg/mL的盐酸右美托咪定注射液氯化钠混合溶液，诱导结束后按0.5 μg/（kg·h）的剂量静脉泵注至手术结束；U+D组患者按上述静脉途径给予含乌司他丁20万单位的氯化钠混合溶液和4 μg/mL的右美托咪定氯化钠混合溶液各50 mL（诱导期及维持期剂量同前）。比较4组患者麻醉诱导前30 min（T1）、手术开始2 h（T2）、气管拔管即刻（T3）和术后12 h（T4）的血糖、血氧分压[p（O2）]、促肾上腺皮质激素（ACTH）、去甲肾上腺素（NE）、心率（HR）、心输出量（CO）、系统血管阻力（SVR）、EVLW和PVPI；记录患者T2～T4时点的液体出入量。观察4组患者不良反应发生情况。结果：4组患者T1时点的各项指标比较，差异均无统计学意义（P＞0.05）。T2～T4时点，N组患者的血糖、ACTH、NE、SVR、EVLW和PVPI均显著高于其余3组，且U、D组显著高于U+D组，差异均有统计学意义（P＜0.05），而U组和D组比较差异均无统计学意义（P＞0.05）；U+D组患者的p（O2）和CO均显著高于其余3组，差异均有统计学意义（P＜0.05），而其余3组患者之间比较差异均无统计学意义（P＞0.05）；N、U组患者的HR显著高于其余2组，差异均有统计学意义（P＜0.05），而N组与U组、D组与U+D组比较差异均无统计学意义（P＞0.05）；4组患者的液体出入量比较，差异均无统计学意义（P＞0.05）。4组患者均未见明显的不良反应发生。结论：右美托咪定联合乌司他丁可明显减轻OLV肺叶切除术患者的应激反应，降低EVLW和PVPI等部分血流及呼吸动力学指标，从而发挥肺保护效应。 |
| ABSTRACT： | OBJECTIVE： To observe the effects of dexmedetomidine combined with ulinastatin on stress reaction indexes， extravascular lung water value （EVLW） and pulmonary vascular permeability indexes （PVPI） and other parameters in one-lung ventilation （OLV） lobectomy patients. METHODS： A total of 80 patients underwent OLV lobectomy selected from the Affiliated Hospital of Southwest Medical University during Nov. 2015-Nov. 2016 were divided into control group （group N）， ulinastatin pretreatment group （group U）， dexmedetomidine continuous pump group （group D）， ulinastatin pretreatment+dexmedetomidine continuous pump group （group U+D）， with 20 cases in each group. Thirty min before anesthesia induction， all patients were given atropine sulfate 0.5 mg intramuscularly and received catheterization of right internal jugular vein and ipsilateral femoral artery under local anesthesia. Based on that， group N was given 0.9％ Sodium chloride injection 100 mL intravenously； group U was given sodium chloride mixed solution 100 mL containing Ulinastatin for injection 200 000 U intravenously； group D was given continuous intravenous pump of Dexmedetomidine hydrochloride injection 2 μg/mL mixed with sodium chloride mixed solution at 1 μg/（kg·h）， and after induction intravenous pump at 0.5 μg/（kg·h） until the end of surgery； group U+D was given Sodium chloride mixed solution containing 200 000 U ulinastatin 50 mL and 4 μg/mL dexmedetomidine sodium chloride mixed solution 50 mL intravenously （same dose as above during induction period and maintenance period）. The levels of blood glucose， partial pressure of oxygen [p（O2）]， adrenocorticotropic hormone （ACTH）， norepinephrine （NE）， heart rate （HR）， cardiac output （CO）， systemic vascular resistance （SVR）， EVLW and PVPI were compared among 4 groups 30 min before anesthesia induction （T1）， 2 h after the beginning of surgery （T2）， immediately after extubation （T3） and 12 h after surgery （T4）. Liquid intake and output volume were recorded during T2-T4. The occurrence of ADR among 4 groups was observed. RESULTS： There was no statistical significance in each index among 4 groups at T1 （P＞0.05）. During T2-T4， the levels of blood glucose， ACTH， NE， SVR， EVLW and PVPI in group N were significantly higher than other 3 groups， and group U and D were significantly higher than group U+D， with statistical significance （P＜0.05）； there was no statistical significance between U and D （P＞0.05）. The levels of p（O2） and CO in groups U+D were significantly higher than other 3 groups， with statistical significance （P＜0.05）； there was no statistical significance among other 3 groups （P＞0.05）. HR of group N and U were significantly higher than other 2 groups， with statistical significance （P＜0.05）. There was no statistical significance between group N and U， between group D and U+D （P＞0.05）. There was no statistical significance in liquid intake or output volume among 4 groups （P＞0.05）. No obvious ADR was found in 4 groups. CONCLUSIONS： Dexmedetomidine combined with ulinastatin can significantly relieve stress reaction， and reduce the levels of part blood flow and respiratory dynamics indexes as EVLW， PVPI in patients with OLV lobectomy so as to play lung protective effect. |
| 期刊： | 2017年第28卷第35期 |
| 作者： | 陶应军，陶广华，吴畏，刘文值，李卫，张文龙，朱月浩，张培茂 |
| AUTHORS： | TAO Yingjun，TAO Guanghua，WU Wei，LIU Wenzhi，LI Wei，ZHANG Wenlong，ZHU Yuehao，ZHANG Peimao |
| 关键字： | 右美托咪定；乌司他丁；单肺通气；应激反应；肺保护 |
| KEYWORDS： | Dexmedetomidine； Ulinastatin； One-lung ventilation； Stress response； Lung protection |
| 阅读数： | 276 次 |
| 本月下载数： | 1 次 |
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