Khddam Ayham, Rostom Faten, Hajeer Mohammad Y
Department of Anesthesia and Resuscitation, Children's Hospital, Damascus University, Damascus, SYR.
Department of Anesthesia, Faculty of Medicine, Damascus University, Damascus, SYR.
Cureus. 2024 Mar 22;16(3):e56693. doi: 10.7759/cureus.56693. eCollection 2024 Mar.
Background One-lung ventilation (OLV) is a common ventilation technique used during thoracic surgery. It can cause serious complications in children, and hypoxic pulmonary vasoconstriction (HPV) is a protective mechanism against the resulting hypoxia. Dexmedetomidine does not affect HPV, so we will investigate its impact on the partial pressure of oxygen in arterial blood (PaO2) and pulmonary shunt fraction (Qs/Qt). Methods Children who underwent OLV were divided into two equal groups. The Dex group received 0.4 μg/kg/h of dexmedetomidine intravenously. The placebo group received normal saline. Two blood samples were taken to analyze arterial and central venous blood gasses during four time periods: T1, 10 minutes after anesthesia; T2, 10 minutes after OLV; T3, 60 minutes after OLV; and T4, 20 minutes after the end of OLV. Heart rate, mean arterial pressure (MAP), PaO2, Qs/Qt, and peak inspiratory pressure (PIP) values were recorded at these time points. Results Regarding heart rate, the Dex group remained relatively stable, whereas the placebo group showed a slight increase in T3 and T4. Concerning MAP, the Dex group had a reduction at T1 compared with the placebo group and remained similar for other points. PaO2 decreased with OLV. However, the Dex group consistently maintained higher PaO2 values than the placebo, especially in T3 and T4. Concerning Qs/Qt, the Dex group maintained lower time values than the placebo group at OLV. Regarding PIP, the Dex group had significantly lower T2 and T3 than the placebo group. Conclusion Administration of dexmedetomidine in children with OLV improves PaO2 and reduces pulmonary shunt fraction (Qs/Qt), thereby improving oxygen transport. It reduces the maximum PIP values, thereby reducing pressure-related complications.
背景 单肺通气（OLV）是胸外科手术中常用的通气技术。它可在儿童中引发严重并发症，而缺氧性肺血管收缩（HPV）是针对由此产生的缺氧的一种保护机制。右美托咪定不影响HPV，因此我们将研究其对动脉血氧分压（PaO2）和肺分流分数（Qs/Qt）的影响。
方法 将接受OLV的儿童分为两组，每组人数相等。右美托咪定组静脉输注0.4μg/（kg·h）右美托咪定。安慰剂组输注生理盐水。在四个时间段采集两份血样以分析动脉血和中心静脉血气体：T1，麻醉后10分钟；T2，OLV后10分钟；T3，OLV后60分钟；T4，OLV结束后20分钟。记录这些时间点的心率、平均动脉压（MAP）、PaO2、Qs/Qt和吸气峰压（PIP）值。
结果 关于心率方面，右美托咪定组保持相对稳定，而安慰剂组在T3和T4时略有升高。关于MAP，右美托咪定组在T1时较安慰剂组降低，其他时间点相似。PaO2随OLV降低。然而，右美托咪定组的PaO2值始终高于安慰剂组，尤其是在T3和T4时。关于Qs/Qt，右美托咪定组在OLV时的时间值低于安慰剂组。关于PIP，右美托咪定组在T2和T3时显著低于安慰剂组。
结论 对接受OLV的儿童给予右美托咪定可改善PaO2并降低肺分流分数（Qs/Qt），从而改善氧输送。它降低了最大PIP值，从而减少了与压力相关并发症的发生。
