右美托咪定对单肺通气期间七氟醚维持患者肺内分流的影响：一项病例对照研究。
Effect of dexmedetomidine on intrapulmonary shunt in patients with sevoflurane maintained during one-lung ventilation: A case-control study.
机构信息
Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China.
出版信息
Medicine (Baltimore). 2022 Nov 18;101(46):e31818. doi: 10.1097/MD.0000000000031818.
BACKGROUND
The effects of dexmedetomidine on the circulatory system are complex. It is difficult to predict its effects on intrapulmonary shunts and hypoxic pulmonary vasoconstriction in patients with one-lung ventilation. This study aimed to investigate the effect of dexmedetomidine on intrapulmonary shunt in patients with sevoflurane during one-lung ventilation.
METHODS
Forty patients requiring thoracoscopic lobectomy were randomly divided into the dexmedetomidine group (Group D, n = 20) and the normal saline group (Group N, n = 20). The arterial partial pressure of oxygen (PaO2), pulmonary shunt fraction (Qs/Qt), mean end-tidal sevoflurane concentration, mean arterial pressure, and heart rate were compared between the 2 groups at 3 time points: (i) after 5 minutes of two-lung ventilation (T0), (ii) after 30 minutes of one-lung ventilation (OLV) (T1), and (iii) after 45 minutes of OLV (T2). The dosage of sevoflurane from the beginning of OLV to T2 was calculated.
RESULTS
There were no significant differences in age, body mass index, and FEV1/FVC between Groups D and N (P > .05). At T0, T1, and T2, the PaO2 levels of Group D and Group N were similar (P > .05), and the PaO2 levels of Group D and Group N decreased after OLV. The Qs/Qt level of Groups D and N were similar at T0 (P > .05), and the level of Groups D and N at T1 and T2 was higher than that at T0. The Qs/Qt of Group D was statistically significantly lower than that of Group N at T1 and T2 (P < .05).
CONCLUSION
Compared with the control group, we found that dexmedetomidine can reduce the intrapulmonary shunt fraction and improve the body's status during OLV.
背景
右美托咪定对循环系统的影响较为复杂，难以预测其对单肺通气患者的肺内分流和低氧性肺血管收缩的影响。本研究旨在探讨右美托咪定对单肺通气患者七氟醚麻醉时肺内分流的影响。
方法
选择择期行胸腔镜肺叶切除术的患者 40 例，随机分为右美托咪定组（D 组，n=20）和生理盐水组（N 组，n=20）。比较两组患者在双肺通气（T0）5 min、单肺通气（OLV）30 min（T1）和 45 min（T2）时的动脉血氧分压（PaO2）、肺内分流量（Qs/Qt）、呼气末七氟醚浓度、平均动脉压和心率。计算从开始 OLV 到 T2 时的七氟醚用量。
结果
D 组和 N 组患者的年龄、体质量指数和 FEV1/FVC 比较，差异无统计学意义（P＞0.05）。T0、T1 和 T2 时，D 组和 N 组患者的 PaO2 水平相似（P＞0.05），OLV 后两组患者的 PaO2 水平均下降；D 组和 N 组患者 T0 时的 Qs/Qt 水平相似（P＞0.05），T1 和 T2 时两组患者的 Qs/Qt 水平均高于 T0 时，且 D 组患者的 Qs/Qt 水平低于 N 组，差异有统计学意义（P＜0.05）。
结论
与对照组相比，右美托咪定可降低单肺通气时的肺内分流率，改善患者机体状态。
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