右美托咪定辅助全身麻醉在开胸肺癌根治术中的应用

Application of Dexmedetomidine as An Adjunct to General Anesthesia for Lung Cancer Radical Operations through Thoracotomy Approach

目的：探讨右美托咪定辅助全身麻醉在开胸肺癌根治术中的临床应用。方法：选择美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级行开胸肺癌根治术的患者30例,通过完全随机方法将其分为右美托咪定组（D组,n=15）和对照组（C组,n=15）。D组患者在麻醉诱导前10 min内静脉微泵输注右美托咪定1μg/kg,后以0.5μg/（kg·h）维持输注至关闭胸腔;C组微泵注射与D组等速度和等容量的0.9%氯化钠液。麻醉诱导采用异丙酚靶控输注（TCI）4μg/mL,芬太尼3μg/kg（D组）或5μg/kg（C组）,罗库溴铵0.9 mg/kg。术中D组患者在必要时可将芬太尼控制在0.1 mg静脉注射;C组患者芬太尼总量控制在8~10μg/kg。记录麻醉诱导前（T0）、诱导后（T1）、气管插管后即刻（T2）、手术开始（T3）、进胸（T4）、开胸后30 min（T5）、开胸后1 h（T6）和手术结束（T7）各时间点脑电双频指数（BIS）、血压、心率（HR）、脉搏血氧饱和度（SpO2）、药物应用情况。结果：与C组比较：D组患者麻醉诱导、气管插管和术中收缩压（SBP）、舒张压（DBP）、HR波动较小;异丙酚[（125.84±36.08）mg比（88.75±22.37）mg]、芬太尼[（0.52±0.04）mg比（0.35±0.06）mg]、罗库溴铵[（105.38±15.60）mg比（82.85±18.15）mg]总用量降低;术中应用降压药控制血压的比例降低[66.7%（10/15）比20.0%（3/15）],差异均有统计学意义（P均〈0.01）。结论：右美托咪定辅助全身麻醉用于开胸肺癌根治术可减少麻醉诱导过程中的血流动力学波动,同时显著减少全身麻醉药、麻醉性镇痛药和肌松药的用量。

Objective：To investigate the application of dexmedetomidine as an adjunct to general anesthesia for lung cancer operations through thoracotomy approach.Methods：A total of 30 patients with ASA gradeⅠ~Ⅱ,scheduled for radical operations of lung cancer through thoracotomy approach,were randomly assigned to 2 groups.Patients in the dexmedetomidine group（Group D,n=15）received an infusion dexmedetodine（1μg/kg）10 min before anesthesia induction and followed by an infusion of 0.5μg/（kg·h）for maintenance.Patients in the control group（Group C,n=15）received the same volume of 0.9%sodium chloride solution at the same speed.Anesthesia induction was performed using target-controlled infusion（TCI）of propofol（4 μg/mL）,fentanyl was used at a dose of 3μg/kg for Group D and 5μg/kg for Group C,and rocuronium（0.9 mg/kg）.Additional fentanyl was injected intermittently during operation with total dose of 8 to 10μg/kg in Group C and injected with a dose of 0.1 mg as needed in Group D.Bispectral index（BIS）,blood pressure（BP）,heart rate（HR）,pulse oxygen saturation（SpO2） were measured and administration of drugs was recorded before（T0）and after（T1）anesthesia induction,after intubation（T2）,at the beginning of operation（T3）,opening chest（T4）,30 min（T5）and 1 h（T6）after opening chest,and at the end of operation（T7）.Results：Compared with group C,patients in group D experienced less challenges for haemodynamic fluctuation（SBP,DBP and HR）,less dose requirement of propofol[（125.84±36.08）mg vs（88.75±22.37）]mg,fentanyl[（0.52±0.04）mg vs（0.35±0.06）mg]and rocuronium[（105.38±15.60）mg vs（82.85±18.15）mg,and less proportion of administrating antihypertensive drug[66.7%（10/15）vs 20.0%（3/15）].There were significant differences between the two groups（Pall0.01）.Conclusions：Dexmedetomidine as an adjunct to general anesthesia for lung cancer operations through thoracotomy approach can be used without undue haemodynamic fluctuation during anesthesia induction and operation,and this method can decrease the requirement for propofol,opioids and non-depolarizing neuromuscular blocking agents.