小剂量多巴胺持续静脉泵注用于老年人胸腔镜下肺叶切除术的临床观察

Continuous intravenous infusion with low dose dopamine for elderly people undergoing thoracoscopic lobectomy

目的：观察小剂量多巴胺持续静脉泵注对老年人胸腔镜下肺叶切除术术中血流动力学及肺氧合功能的影响。方法：选择80例择期行胸腔镜下肺叶切除术的老年患者,年龄60~82岁,ASAⅠ~Ⅱ级,随机均分多巴胺组（观察组）和生理盐水组（对照组）。观察组诱导插管后持续静脉泵注多巴胺2~5μg·kg-1·min-1,术中适当调整剂量,保持血压稳定;而对照组持续静脉泵注生理盐水,必要时给予多巴胺1~2mg单次静脉推注,以维持一定的血压。记录两组入室时（T0）、全麻诱导插管时（T1）、进入胸腔单肺通气时（T2）、肺叶切除时（T3）、双肺通气时（T4）、拔管时（T5）的MAP、HR,并于T2、T3、T4时测动脉血气,记录PaCO2和PaO2,计算肺泡-动脉氧分压差P（A-a）O2及肺氧合指数PaO2/FiO2,同时记录整个手术过程出入量（包括尿量、出血量、术中补液量）及术后随访出现并发症情况。结果：观察组在T2、T3、T4、T5时的MAP、HR明显平稳于对照组,差异具有统计学意义（P〈0.05）;观察组在T2、T3、T4时的P（A-a）O2低于对照组,PaO2/FiO2则高于对照组,差异具有统计学意义（P〈0.05）;观察组术中尿量多,出血量少,术中补液量明显减少,术后随访心衰、肺水肿等并发症发生少。结论：小剂量多巴胺持续静脉泵注用于老年人胸腔镜下肺叶切除术术中血流动力学更平稳,单肺通气后肺氧合功能明显改善,术后并发症少,值得推广应用。

Objective：To observe the effect of continuous intravenous infusion with low dose dopamine function on hemodynamic changes and oxygenated function. Methods： A total of 80 elderly patients （age： 60-82 years old） undergoing thoracoscopic lobectomy ascribed as ASA Ⅰ-Ⅱgrade were randomly divided into dopamine group （observation group） and nor- mal saline （control group）. After intubation, the observation group was given continuous intravenous infusion of dopamine 2- 5ug / （kg.min）, infusion dose was adjusted to maintain stable blood pressure during the surgery. While the control group wasgiven continuous intravenous infusion of saline, and dopamine （1-2 mg） when necessary by single intravenous bolus injection to maintain stable blood pressure. MAP and HR were recorded before induction of anesthesia intubation （T0）, general anesthesia intubation induction （T1）, one-lung ventilation （T2）, lobectomy （T3）, both lung ventilation （T4）, extubation （T5）. PaCO2 and PaO2 were also recorded at T2, T3, T4, P（Aa） O2 and pulmonary oxygenation index PaO2/ FiO2 were calculated. Urine , blood loss volumn, intraoperative fluid supplemental volume and postoperative follow-up complications were also recorded. Results： At T2, T3, T3 , and T5, MAP and HR of the observation group was significant more stable than the control group （P 〈0.05） ; At T2, T3, T4 when P （Aa） O2 of the observation group was significant lower than the control group, while PaO2/ FiO2 was higher （P〈0.05）;During the surgery procedure, urine volume, bleeding volume, and fluid supplemental volume were all significant less than the control group. According to follow-up data, Incidence of heart failure, pulmonary edema and other complications occurred less frequently in the observation group. Conclusion： Continuous intravenous infusion with low dose dopamine can keep stable hemodynamic parameters, improve oxygenated function during one-lung ventilation period without inducing high incidence of complications, and it＇s worthy of application in large scale.