右美托咪定对中度慢性阻塞性肺疾病合并肺癌患者术中肺氧合作用、肺呼吸力学参数的影响

Effect of dexmetomidine on lung oxygenation in lung cancer patients with moderate chronic obstructive pulmonary disease and the improvement of pulmonary respiratory mechanical parameters

目的探讨中度慢性阻塞性肺疾病(COPD)合并肺癌患者术中应用右美托咪定对其机体肺氧合作用、肺呼吸力学参数的影响。方法随机选取78例肺癌合并中度COPD患者分为研究组与对照组,每组39例。两组肺癌合并中度COPD患者均接受外科手术治疗,术中两组肺癌合并中度COPD患者分别使用不同的麻醉方案,即研究组在单肺通气开始后,待其机体血流动力学稳定且维持后15 min加用右美托咪定微量泵注,对照组于相同时机给予生理氯化钠溶液微量泵注。结果两组单肺通气30 min(T1)时肺氧合指数、动脉血二氧化碳分压(Pa CO_2)测量值比较,差异未见统计学意义(P> 0. 05);右美托咪定使用后30 min(T2)时研究组Pa CO_2较T1下降幅度大于对照组,差异未见统计学意义(P> 0. 05); T3时两组Pa CO_2均较T2有所回升,但研究组仍低于对照组,差异有统计学意义(P <0. 05); T2、T3时研究组肺氧合指数较T1显著提高,差异有统计学意义(P <0. 05),对照组各时间点肺氧合指数比较,差异未见统计学意义(P> 0. 05)。结论应用右美托咪定对改善接受外科手术治疗的肺癌合并中度COPD患者肺氧合作用、呼吸力学参数均具有积极意义,有利于保障其手术安全性及预后。

Objective To investigate the effect of dexmetomidine on pulmonary oxygenation and respiratory mechanical parameters in lung cancer patients with moderate chronic obstructive pulmonary disease（ COPD）. Methods Seventy-eight cases of lung cancer with moderate COPD were randomly selected and divided into the study group and the control group,with 39 cases in each group. The two groups were treated by surgery. The two groups were treated with different anesthetic protocols,that is,the study group was treated with single lung ventilation,when the hemodynamics was stable and 15 min was maintained, dexmetomidine was added to the micropump, while the control group was given physiological saline micropump at the same time. Results The pulmonary oxygenation index and arterial partial pressure of carbon dioxide（ PaCO2） at 30 min（ T1） ventilation were compared between the two groups,the differences were not significant（ P〉0. 05）. When the dexmedetomidine was used 30 min（ T2）,the decrease of PaCO2 in study group was more than that in T1 group,the difference was not significant（ P〉 0. 05）. At the time of T3,the PaCO2 of the two groups increased compared with that of T2,but the study group was still lower than the control group,the difference was significant（ P〈 0. 05）.At T2 and T3,the lung oxygenation index of the study group was significantly higher than that of T1 in,the difference was significant（ P〈 0. 05）. There was no significant difference the pulmonary oxygenation index at each time point in the control group（ P〈 0. 05）. Conclusions Dexmeto midine has positive effect on the pulmonary oxyenation and respiratory mechanics in patients with moderate COPD with surgical treatment,and it is beneficial to ensure the safety and prognosis of the surgery.