右美托咪定对行腹腔手术脓毒症患者肺氧合和换气功能的影响

Effects of Dexmedetomidine on Pulmonary Oxygenation and Ventilation in Sepsis Patients Undergoing Abdominal Surgery

目的观察右美托咪定对行开腹手术脓毒症患者肺泡-动脉氧分压差(alveolo-arterial oxygen partial pressure difference,A-aDO2)、氧合指数(oxygenation index,OI)和呼吸指数(respiratory inDex,RI)的影响。方法选择2016年5月-2018年4月行开腹手术治疗的脓毒症患者50例,男27例,女23例,年龄18～65岁,BMI18～30kg·m^(-2),ASA分级Ⅲ～Ⅳ级,采用区组化随机的方法将患者随机分为两组,分别为右美托咪定组(D组)和生理盐水组(C组),每组25例。D组于麻醉诱导前经静脉以1μg·kg^(-1)的负荷量泵入右美托咪定,20min注射完毕,之后持续以0.5μg·(kg·h)^(-1)的速率持续泵入直至术毕;C组患者同样在麻醉诱导前20min以相同的速度泵入生理盐水。分别在麻醉诱导前20min(T_0)、冲洗腹腔后5min(T_1)和手术结束时(T_2)抽取患者动脉血,利用血气分析检测患者PaO_2,PaCO_2并计算A-aDO2、OI、RI指标。同时记录患者APACHE Ⅱ评分,手术持续时间,输入液体量,输血例数及输血量和血管活性药物用量。结果两组患者的一般资料及T_0时刻的A-aDO2、OI和RI指标差异均无统计学意义(P均>0.05)。与T_0比较,T_1及T_2时刻患者A-aDO2和RI上升,但A-aDO2和RI指标D组患者均低于C组(P均<0.05);与C组比较,D组在T_1和T_2时间点OI值升高(P<0.05);两组患者APACHE Ⅱ评分、手术持续时间、输入液体量、输血例数及输血量和血管活性药物用量差异均无统计学意义(P均>0.05)。结论右美托咪定可改善行开腹手术治疗的脓毒症患者的肺氧合和换气功能,可能具有一定的肺保护作用。

Objective To assess the effects of dexmedetomidine on alveolo-arterial oxygen partial pressure difference(A-aDO2),oxygenation index(OI)and respiratory in Dex(RI)in sepsis patients undergoing abdominal surgery.Methods Fifty patients(male 27 and female 23,BMI 18-30kg·m^-2,ASAⅢ-Ⅳ,aged 18-65 years old)with sepsis requiring abdominal cleaning focus of infection under general anesthesia were involved.Patients were randomly divided into Dexmedetomidine group(group D,n=25)and control group(group C,n=25).In group D,patients received a loading infusion of Dexmedetomidine(1μg·kg^-1)intravenously for 20 min before induction of anesthesia and followed by a maintenance infusion 0.5μg·(kg·h)^-1 until the end of the surgery.In group C,the patients received matching placebo(equal volume of normal saline).Arterial blood samples were sampled 20 min before anesthesia,5 min after irrigation of the abdominal cavity and at the end of surgery for assaying PO2,PCO2,A-aDO2,OI and RI levels by using blood gas analyzer.The score of APACHEⅡ,the duration of surgery,the liquid volume,the casesand volumeof blood transfusion and the dosages of vasoactive agent were also recorded.Results There were no statistical significance on A-aDO2,OI and RI at T0 between the two groups.Compared with T0,the A-aDO2 and RI were significantly increased in the two groups at T1 and T2,but the increase was significantly more in group C(P<0.05).OI was significantly decreased in the patients of group C than that of group D at T1 and T2(P<0.05).There was no significant difference in APACHEⅡscore,duration of operation,volume of infusion fluid,number of transfusion cases,volume of transfusion and dosage of vasoactive drugs between the two groups(P all>0.05).Conclusion Dexmedetomidine can improve pulmonary oxygenation and ventilation function in sepsis patients undergoing abdominal cleaning focus of infection,which maybe has the effect of lung protection.