右美托咪定对胸腔辅助胸外科围手术期老年患者血流动力学的影响

Effect of Dexmedetomidine on Hemodynamics of Elderly Patients During the Perioperative Period of Thoracic Assisted Thoracic Surgery

目的探讨右美托咪定对胸腔辅助胸外科手术围手术期老年患者血流动力学的影响。方法随机选取2021年1月~2022年1月于我院行胸腔镜辅助下肺叶切除术的肺癌患者87例,按照随机数字表法分为研究组(n=44)和对照组(n=43)。两组患者均采用气管插管全麻,麻醉诱导结束后,研究组给予盐酸右美托咪定静脉输注,对照组输注等量生理盐水,比较两组患者手术开始前(T0)、拔管时(T1)血流动力学[心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SaO_(2))、心脏指数(CI)、心输出量(CO)、外周循环阻力(SVR)、左心室射血分数(LVEF)]变化,比较两组拔管时T1、拔管后15min(T2)时Ramsay评分变化,比较两组患者术后不良反应差异。结果两组患者T0时HR、SBP、DBP、SaO_(2)、CI、CO、SVR比较均无明显差异(P>0.05);两组T1时HR、SBP、DBP、CI、CO、SVR均高于同组T0时,且相比对照组,研究组明显偏低(P<0.05);与对照组相比,研究组T1、T2时Ram⁃say评分均明显偏高(P<0.05);两组术后不良反应发生率比较均无明显差异(P>0.05)。结论右美托咪定应用于胸腔镜辅助下胸外科手术中有利于改善患者围手术期血流动力学,改善术后镇静状态,为临床决策提供一定参考。

Objective To investigate the effect of dexmedetomidine on hemodynamics in elderly patients undergo⁃ing thoracic surgery.Methods Eighty-seven patients with early lung cancer who underwent thoracoscopic lobec⁃tomy in our hospital from January 2021 to January 2022 were randomly selected and divided into the study group(n=44)and the control group(n=43)according to the random number table.Both groups were given gen⁃eral anesthesia by tracheal intubation.After anesthesia induction,the study group was given dexmedetomidine hy⁃drochloride intravenously and the control group was given the same amount of normal saline.Hemodynamics[heart rate(HR),systolic pressure(SBP),diastolic pressure(DBP),oxygen saturation(SaO_(2)),cardiac index(CI),cardiac output(CO),peripheral circulation resistance(SVR)and left ventricular ejection fraction(LVEF)]were compared between the two groups before operation(T0)and at extubation(T1).Results There was no signifi⁃cant difference in HR,SBP,DBP,SaO2,CI,CO and SVR between the two groups at T0(P>0.05).HR,SBP,DBP,CI,CO and SVR in the two groups were higher at T1 than those in the same group,and were signifi⁃cantly lower in the study group than in the control group(P<0.05).Compared with the control group,the Ram⁃say scores in the study group were significantly higher at T1 and T2(P<0.05).There was no significant differ⁃ence in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion The ap⁃plication of dexmedetomidine in thoracoscopic assisted thoracic surgery is beneficial to improve perioperative he⁃modynamics and postoperative sedation,and provides some reference for clinical decision-making.