肺保护性通气策略联合右美托咪定用于单肺通气肺癌根治术的效果

Clinical efficacy of lung protective ventilation strategy and dexmedetomidine in radical resection of lung cancer with one-lung ventilation

目的观察肺保护性通气策略联合右美托咪定在单肺通气肺癌根治术中效果。方法80例行单肺通气肺癌根治术患者随机分为观察组和对照组,分别采用肺保护性通气策略联合右美托咪定或肺保护性通气策略。比较两组应激反应、肺功能、呼吸力学、术后恢复指标及肺部并发症。结果与对照组相比,观察组在麻醉诱导前10 min(T0)、通气即刻(T1)、通气30 min(T2)、通气60 min(T3)、手术结束(T4)、恢复双肺通气15 min(T5)时氧合指数和动脉血氧分压均高于对照组(P<0.01),而T2~T5时气道阻力低于对照组(P<0.01);观察组苏醒期躁动明显减少,术后恢复自主呼吸和术后清醒时间明显缩短(P<0.01或0.05);T4、术后1 d(T6)时血清丙二醛低于对照组,超氧化物歧化酶高于对照组(P<0.01或0.05)。结论在单肺通气肺癌根治术中采用肺保护性通气策略联合右美托咪定可抑制应激反应,改善肺功能和呼吸力学。

Objective To observe the efficacy of lung protective ventilation strategy(LPVS)and dexmedetomidine in radical resection of lung cancer(RRLC)with one-lung ventilation(OLV).Methods Eighty patients undergoing RRLC with OLV were randomly treated with LPVS plus dexmedetomidine(observation group)or single LPVS(control group).The stress response,pulmonary function,respiratory mechanics,postoperative recovery,and pulmonary complications were compared between two groups.Results Compared with control group,oxygenation index and PaO_(2) at 10 min before anesthesia induction(T0),immediately(T1),30 min(T2)and 60 min(T3)after ventilation,end of operation(T4),and 15 min after two-lung ventilation(T5)were higher(P<0.01),while airway resistance at T2-T5 was lower in observation group(P<0.01);agitation during recovery period,postoperative spontaneous breathing recovery and waking time were lower in observation group(P<0.01 or 0.05);serum MDA level was decreased but SOD increased at T4 and T6(1 day postoperation)in observation group(P<0.01 or 0.05).Conclusion Combined LPVS and dexmedetomidine can inhibit stress response and improve pulmonary function and respiratory mechanics during RRLC with OLV.