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右美托咪定对七氟醚全身麻醉下动态肺顺应性的影响:一项随机对照研究。

Effects of dexmedetomidine on dynamic lung compliance in general anesthesia with desflurane: A randomized controlled study.

作者信息

Wang Xiaoli, Gong Chao, Zhang Yi, Li Shitong, Huang Lina, Chen Lianhua

机构信息

Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, No. 650, New Songjiang Road, Shanghai, 201620, China.

Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 650, New Songjiang Road, Shanghai, 201620, China.

出版信息

Heliyon. 2023 May 24;9(6):e16672. doi: 10.1016/j.heliyon.2023.e16672. eCollection 2023 Jun.

Abstract

OBJECTIVE

The aim of this study was to evaluate the effect of dexmedetomidine on lung compliance in patients under general anesthesia with desflurane.

METHODS

This prospective, randomized, double-blind, controlled trial included 51 patients who received general anesthesia undergoing lower limb fracture surgery. Participants were assigned to either the experimental (loading dose of 0.25 μg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.3 μg/kg/h until the end of the surgery) or control (0.9% saline) group. Anesthesia was maintained with desflurane, analgesics and muscle relaxants. The two groups were compared for hemodynamic parameters, dynamic lung compliance, oxygenation index, and postoperative complications.

RESULTS

While dynamic lung compliance showed no significant difference between the two groups at T1 ( = 0.321), it was significantly higher in the experimental group at all other time points (all  < 0.001). In the control group, Cdyn at T4, T5, T6, and T7 were lower than that at T1 ( = 0.032, 0.043, 0.032 and 0.018, respectively). There were no significant between-group differences in the mean arterial pressure and heart rate. Compared to the control group, the experimental group had a higher oxygenation index at T1 ( < 0.001), T2 ( < 0.001), T3 ( < 0.001), T4 ( = 0.02), and T5 ( = 0.016) and significantly lower peak airway pressure at all time points (all  < 0.001). Both groups had comparable postoperative outcomes.

CONCLUSIONS

Dexmedetomidine infusion at a loading dose of 0.25 μg/kg and maintenance dose of 0.3 μg/kg/h improved dynamic lung compliance in patients receiving desflurane during general anesthesia.

摘要

目的

本研究旨在评估右美托咪定对接受地氟烷全身麻醉患者肺顺应性的影响。

方法

这项前瞻性、随机、双盲、对照试验纳入了51例接受下肢骨折手术全身麻醉的患者。参与者被分配到试验组(10分钟内静脉注射负荷剂量0.25μg/kg右美托咪定,随后以0.3μg/(kg·h)的维持剂量持续至手术结束)或对照组(0.9%生理盐水)。采用地氟烷、镇痛药和肌肉松弛剂维持麻醉。比较两组的血流动力学参数、动态肺顺应性、氧合指数和术后并发症。

结果

虽然两组在T1时动态肺顺应性无显著差异(P = 0.321),但在其他所有时间点试验组的动态肺顺应性均显著更高(均P < 0.001)。在对照组中,T4、T5、T6和T7时的Cdyn低于T1时(分别为P = 0.032、0.043、0.032和0.018)。两组的平均动脉压和心率无显著组间差异。与对照组相比,试验组在T1(P < 0.001)、T2(P < 0.001)、T3(P < 0.001)、T4(P = 0.02)和T5(P = 0.016)时的氧合指数更高,且在所有时间点的气道峰压均显著更低(均P < 0.001)。两组术后结果相当。

结论

负荷剂量0.25μg/kg和维持剂量0.3μg/(kg·h)的右美托咪定输注可改善全身麻醉期间接受地氟烷患者的动态肺顺应性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b3a/10360578/6cc091fca8ac/gr1.jpg

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