摘要
目的分析单肺通气肺叶切除术中应用气管内右美托咪定给药对肺癌患者肺保护和全身麻醉苏醒期的影响。方法本研究进行回顾性分析,将2021年11月至2022年8月在安徽省胸科医院行单肺通气下肺叶切除术治疗的84例肺癌患者分为对照组和观察组,各42例。在气道插管成功后给予对照组患者静脉泵注1μg/kg右美托咪定,给予观察组患者经气道导管注入1μg/kg右美托咪定。在麻醉诱导即刻(T_(0))、单肺通气30 min(T_(1))、单肺通气60 min(T_(2))、恢复双肺通气30 min(T_(3))和术毕(T_(4))时动脉血气指标[氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(OI)]、心率和平均动脉压(MAP)。记录两组患者术后自主呼吸恢复时间、胸管留置时间、住院时间、拔管期间呛咳评分和镇静-躁动评分(SAS)、不良反应发生情况。结果观察组患者T_(1)~T_(4)时刻PaO_(2)为(131.81±14.93)、(154.75±25.65)、(228.27±30.55)、(169.43±18.58)mmH_(2)O,OI为(203.27±33.83)、(261.63±27.54)、(530.75±40.68)、(416.28±35.94)mmHg,均显著高于对照组[(108.63±17.26)、(139.16±23.73)、(197.54±32.19)、(153.28±20.32)mmH 2O;(160.93±28.73)、(217.26±34.38)、(428.29±38.92)、(376.27±30.75)mmHg],差异均有统计学意义(P<0.05)。两组患者不同时刻心率和MAP比较及组内比较无显著差异(P>0.05)。观察组患者术后自主呼吸恢复时间、胸管留置时间、住院时间显著少于对照组,拔管期间呛咳评分、SAS评分和不良反应总发生率为[(8.26±2.18)min、(3.45±1.53)d、(7.74±2.58)d、(1.42±0.35)分、(3.35±1.10)分、7.14%],均显著低于对照组[(9.87±2.64)min、(4.89±1.64)d、(9.63±2.93)d、(2.27±0.54)分、(4.25±1.25)分、26.19%],差异均有统计学意义(P<0.05)。结论经气管导管注入右美托咪定能够显著改善单肺通气肺叶切除术炎症水平,减少术后不良反应,加快术后恢复,对肺保护作用优于静脉注射。
Objective To analyze the effect of intratracheal administration of dexmedetomidine on lung protection and recovery from general anesthesia in patients with lung cancer undergoing one lung ventilation pulmonary lobectomy.Methods In this retrospective analysis,84 lung cancer patients who underwent single lung ventilation lobectomy at Anhui Chest Hospital between November 2021 and August 2022 were divided into control and observation groups of 42 patients,each.After successful airway intubation,1μg/kg of dexmedetomidine was given to patients in the control group and 1μg/kg of dexmedetomidine in the observation group.At the time of anesthesia induction(T_(0)),single lung ventilation for 30 min(T_(1)),single lung ventilation for 60 min(T_(2)),recovery of double lung ventilation for 30 min(T_(3)),and at the end of operation(T_(4)),arterial blood gas indexes[partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(OI)],heart rate,and mean arterial pressure(MAP).The recovery time of spontaneous respiration,chest tube indwelling time,hospital stay,cough score and sedation agitation score(SAS)during extubation,adverse reactions were recorded.Results PaO_(2)in the observation group at T_(1)-T_(4)were PaO_(2)(131.81±14.93),(154.75±25.65),(228.27±30.55),(169.43±18.58)mmH_(2)O,OI were(203.27±33.83),(261.63±27.54),(530.75±40.68),(416.28±35.94)mmHg,which were higher than those in the control group[PaO_(2):(108.63±17.26),(139.16±23.73),(197.54±32.19),(153.28±20.32),(160.93±28.73),(217.26±34.38),(428.29±38.92),(376.27±30.75)mmHg],and the differences were statistically significant(P<0.05).There was no difference in HR,MAP and intra group comparison between the two groups at different times(P>0.05).The recovery time of spontaneous respiration,retention time of chest tube,stay time in hospitalization time of patients in the observation group were shorter than those in the control group,and the cough score,SAS score and total incidence of adverse reactions during extubation were[(8.26±2.18)min,(3.45±1.53)d,(7.74±2.58)d,(1.42±0.35)min,(3.35±1.10)min,and 7.14%],which were significantly lower than those in the control group[(9.87±2.64)min,(4.89±1.64)d,(9.63±2.93)d,(2.27±0.54)points,(4.25±1.25)points,26.19%],and the differences were statistically significant(P<0.05).Conclusion Dextrmedetomidine injected through an air tube catheter can significantly improve the inflammatory level of one lung ventilation pulmonary lobectomy,reduce postoperative adverse reactions,speed up postoperative recovery,and has better lung protection than intravenous injection.
作者
孔婧
张欢欢
姚晶曼
胡友洋
KONG Jing;ZHANG Huan-huan;YAO Jing-man(Department of Anesthesiology,Anhui Chest Hospital,Hefei Anhui 230031,China)
出处
《临床和实验医学杂志》
2023年第6期662-666,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省卫生健康委重点立项项目(编号:AHWJ2021a024)。
关键词
单肺通气
肺叶切除术
气管内给药
右美托咪定
肺保护
全麻苏醒期
One lung ventilation
Lobectomy
Intratracheal administration
Dextrmedetomidine
Lung protection
Resuscitation period of general anesthesia
