右美托咪定联合乌司他丁对单肺通气肺叶切除术患者应激反应指标等的影响

发布时间：2018-04-18 01:02

本文选题：右美托咪定 + 乌司他丁　；参考：《中国药房》2017年35期

【摘要】：目的:观察右美托咪定联合乌司他丁对单肺通气肺叶切除术患者应激反应指标、血管外肺水值(EVLW)和肺血管通透性指数(PVPI)等的影响。方法:选择2015年11月-2016年11月在西南医科大学附属医院行单肺通气肺叶切除术的患者80例,按随机数字表法分为对照组(N组)、乌司他丁预处理组(U组)、右美托咪定持续泵注组(D组)、乌司他丁预处理+右美托咪定持续泵注组(U+D组),各20例。全部患者在麻醉诱导前30 min,肌内注射硫酸阿托品0.5 mg,局麻下行右侧颈内静脉及同侧股动脉穿刺置管。在此基础上,N组患者静脉滴注0.9%氯化钠注射液100 m L;U组患者静脉滴注含注射用乌司他丁20万单位的氯化钠混合溶液100 m L;D组患者按1μg/(kg·h)的剂量持续静脉泵注2μg/m L的盐酸右美托咪定注射液氯化钠混合溶液,诱导结束后按0.5μg/(kg·h)的剂量静脉泵注至手术结束;U+D组患者按上述静脉途径给予含乌司他丁20万单位的氯化钠混合溶液和4μg/m L的右美托咪定氯化钠混合溶液各50 m L(诱导期及维持期剂量同前)。比较4组患者麻醉诱导前30 min(T1)、手术开始2 h(T2)、气管拔管即刻(T3)和术后12 h(T4)的血糖、血氧分压[p(O2)]、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、心率(HR)、心输出量(CO)、系统血管阻力(SVR)、EVLW和PVPI;记录患者T2～T4时点的液体出入量。观察4组患者不良反应发生情况。结果:4组患者T1时点的各项指标比较,差异均无统计学意义(P0.05)。T2～T4时点,N组患者的血糖、ACTH、NE、SVR、EVLW和PVPI均显著高于其余3组,且U、D组显著高于U+D组,差异均有统计学意义(P0.05),而U组和D组比较差异均无统计学意义(P0.05);U+D组患者的p(O2)和CO均显著高于其余3组,差异均有统计学意义(P0.05),而其余3组患者之间比较差异均无统计学意义(P0.05);N、U组患者的HR显著高于其余2组,差异均有统计学意义(P0.05),而N组与U组、D组与U+D组比较差异均无统计学意义(P0.05);4组患者的液体出入量比较,差异均无统计学意义(P0.05)。4组患者均未见明显的不良反应发生。结论:右美托咪定联合乌司他丁可明显减轻OLV肺叶切除术患者的应激反应,降低EVLW和PVPI等部分血流及呼吸动力学指标,从而发挥肺保护效应。
[Abstract]:Aim: to observe the effects of dexmetomidine combined with ulinastatin on stress response, extravascular lung water value (EVLW) and pulmonary vascular permeability index (PVPI) in patients undergoing single lung ventilation lobectomy.Methods: from November 2015 to November 2016, 80 patients underwent single lung ventilation lobectomy in the affiliated Hospital of Southwest Medical University.According to the random digital table method, the rats were divided into control group (n group), ulinastatin preconditioning group (group U), dexmetomidine continuous pump group (group D) and ulinastatin preconditioning group (n = 20).All patients received intramuscular injection of atropine sulfate (0.5 mg) 30 minutes before anesthesia induction. Local anesthesia was performed on the right internal jugular vein and ipsilateral femoral artery catheterization.On the basis of this, the patients in group N received 0.9% sodium chloride injection 100ml / L intravenously, and patients in group A received intravenous infusion of 2 渭 g / mL of urinastatin 200000 units of sodium chloride mixed solution for injection at a dose of 1 渭 g/(kg / h.Dexmetomidine hydrochloride injection sodium chloride mixed solution,After induction (0.5 渭 g/(kg / h), the patients in the UD group received intravenous injection of urinastatin 200000 units of sodium chloride mixed solution and 4 渭 g / mL dexmetomidine sodium chloride mixture solution of 50 mL each (5 渭 g / mL).The dose in induction period and maintenance period was the same as that in prednisone.The blood glucose levels of the four groups were compared 30 min before anesthesia induction, 2 h after operation, 3 h after tracheal extubation (T3) and 12 h after T4).Blood oxygen partial pressure (PPO _ 2), adrenocorticotropic hormone (ACTH), norepinephrine (NE), heart rate (HRT), cardiac output (T2~T4), systemic vascular resistance (SVR), EVLW and PVPIwere recorded.Adverse reactions were observed in 4 groups.Results there was no significant difference in all the indexes at T1 time point between the two groups. The EVLW and PVPI of the N group were significantly higher than those of the other three groups, and the levels of EVLW and PVPI in the UD group were significantly higher than those in the UD group.The difference was statistically significant (P 0.05), but there was no significant difference between group U and group D (P 0.05) and CO in group D were significantly higher than those in the other three groups.The differences were statistically significant (P 0.05), but there was no significant difference among the other three groups. The HR of the patients in the P0.05 group was significantly higher than that in the other two groups.The difference was statistically significant (P 0.05), but there was no significant difference between N group and U group D group and U D group.Conclusion: dexmetomidine combined with ulinastatin can significantly reduce the stress response of patients with OLV lobectomy, decrease some hemodynamic indexes such as EVLW and PVPI, and thus play a protective role in lung protection.
【作者单位】：西南医科大学临床医学院;攀枝花学院附属医院麻醉科;
【基金】：四川省医学科研青年创新课题计划立项(No.Q15052)
【分类号】：R614

【相似文献】