单肺通气期间输注右美托咪定对胸腔镜下老年肺部手术患者氧合和呼吸力学的影响

Effects of dexmedetomidine infusion during one-lung ventilation on oxygenation and respiratory mechanics in elderly patients undergoing thoracoscopic lung surgery

目的探讨单肺通气(OLV)期间输注右美托咪定对胸腔镜下老年肺部手术患者的氧合和呼吸力学影响。方法选取158例电视辅助胸腔镜手术(VATS)下行肺叶切除术的老年患者,根据随机数字法分为观察组(80例)和对照组(78例)。观察组术中予以盐酸右美托咪定泵注,对照组予以生理盐水泵注。统计2组不同时刻氧合指数、呼吸力学指标和血流动力学指标差异;观察2组术中低氧血症和术后的肺部并发症发生情况。结果观察组T1和T2时刻PaO2/FiO2均显著高于对照组(均P<0.05);T1和T2时刻观察组Ppeak、Pmean和VD/VT均显著低于对照组(均P<0.05);观察组T1和T2时刻Cdyn均显著高于对照组(均P<0.05);观察组T1和T2时刻MAP显著低于对照组水平(均P<0.05),且观察组HR虽然低于对照组,但差异无统计学意义(P>0.05)。2组术中均未出现低氧血症病例,且观察组术后肺部并发症发生率(0.00%)显著低于对照组(11.54%,χ2=7.758,P=0.005)。结论老年VATS手术患者在OLV期间输注右美托咪定,有助于改善呼吸力学,提高氧合能力,减少术后肺部并发症的发生率,值得临床应用。

Objective To investigate the effects of dexmedetomidine infusion during one-lung ventilation(OLV) on oxygenation and respiratory mechanics in elderly patients undergoing thoracoscopic lung surgery. Methods A total of 158 elderly patients undergoing video-assisted thoracoscopic surgery(VATS) from November 2015 to November 2018 for lobectomy were selected and divided into observation group(80 cases) and control group(78 cases) according to the principle of random number method. The observation group was given dexmedetomidine hydrochloride pump during operation, while the control group was given physiological salt pump. The differences of oxygenation index, respiratory mechanics index and hemodynamics index at different time between the two groups were analyzed. The hypoxemia during operation and pulmonary complications after operation were observed. Results PaO2/FiO2 at T1 and T2 were significantly higher in the observation group than in the control group, There was no statistical significance(all P>0.05). There were no cases of hypoxemia in the two groups, and the incidence of pulmonary complications in the observation group(0.00%) was significantly lower than that in the control group(11.54%,χ2=7.758, P=0.005). Conclusion The infusion of dexmedetomidine during OLV in elderly patients undergoing VATS is helpful to improve respiratory mechanics, increase oxygenation capacity and reduce the incidence of pulmonary complications. It is worthy of clinical application.