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右美托咪定联合异氟烷吸入对胸科手术单肺通气后氧合的影响

Effect of Dexmedetomidine Combined with Inhalation of Isoflurane on Oxygenation Following One-Lung Ventilation in Thoracic Surgery.

作者信息

Asri Somayeh, Hosseinzadeh Hamzeh, Eydi Mahmood, Marahem Marzieh, Dehghani Abbasali, Soleimanpour Hassan

机构信息

Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran.

Department of Physiology, Tabriz University of Medical Sciences, Tabriz, Iran.

出版信息

Anesth Pain Med. 2020 Feb 12;10(1):e95287. doi: 10.5812/aapm.95287. eCollection 2020 Feb.

Abstract

BACKGROUND

One-lung ventilation (OLV) is commonly used during thoracic surgery. At this time, hypoxemia is considered one of the remarkable consequences of the anesthesia management. Hypoxic pulmonary vasoconstriction (HPV) is the defense mechanism against hypoxia.

OBJECTIVES

The aim of the present study was to investigate the effect of infusion of dexmedetomidine on improving the oxygenation during OLV among the adult patients undergoing thoracic surgery.

METHODS

A total of 42 patients undergoing OLV by general anesthesia with isoflurane inhalation were randomly assigned into two groups: IV infusion of dexmedetomidine at 0.3 microgram/kg/h (DISO) and IV infusion of normal saline (NISO). Three Arterial Blood Gas (ABG) samples were obtained throughout the surgery. Hemodynamic parameters, PaO, PaCO, and complications at recovery phase were recorded. The collected information was analyzed using SPSS software version 22.

RESULTS

In the dexmedetomidine group, the mean hemodynamic parameters had a significant reduction at 30 and 60 minutes following OLV. Administration of dexmedetomidine resulted in a significant increase in the PaCO and a reduction in the PaO when changing from two-lung ventilation to OLV, where PaO reached its maximum value within 10 minutes after OLV in the DISO group, and it began to gradually increase to the end of operation. The duration of the recovery phase, also complications at the recovery phase decreased significantly in DISO group.

CONCLUSIONS

The results of the study showed that, dexmedetomidine may improve arterial oxygenation during OLV in adult patients undergoing thoracic surgery, and can be a suitable anesthetic agent for thoracic surgery.

摘要

背景

单肺通气(OLV)常用于胸外科手术。此时,低氧血症被认为是麻醉管理的显著后果之一。缺氧性肺血管收缩(HPV)是对抗缺氧的防御机制。

目的

本研究旨在探讨输注右美托咪定对接受胸外科手术的成年患者在OLV期间改善氧合的效果。

方法

总共42例接受异氟烷吸入全身麻醉下OLV的患者被随机分为两组:以0.3微克/千克/小时的速度静脉输注右美托咪定(DISO)组和静脉输注生理盐水(NISO)组。在整个手术过程中采集三份动脉血气(ABG)样本。记录血流动力学参数、PaO、PaCO以及恢复阶段的并发症。使用SPSS 22.0软件对收集到的信息进行分析。

结果

在右美托咪定组中,OLV后30分钟和60分钟时平均血流动力学参数显著降低。从双肺通气改为OLV时,输注右美托咪定导致PaCO显著升高,PaO降低,其中DISO组在OLV后10分钟内PaO达到最大值,并在手术结束前开始逐渐升高。DISO组恢复阶段的持续时间以及恢复阶段的并发症也显著减少。

结论

研究结果表明,右美托咪定可能改善接受胸外科手术的成年患者在OLV期间的动脉氧合,并且可以成为胸外科手术合适的麻醉剂。

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