右美托咪定对老年脊柱后入路手术患者肺功能的影响

发布时间：2018-06-08 23:26

本文选题：右美托咪定 + 肺功能　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨在全身麻醉的状态下,经静脉给予右美托咪定对老年脊柱后入路手术患者肺功能的影响。方法:选择择期在青岛大学附属医院崂山院区行脊柱后入路手术符合实验条件的老年患者60例为实验研究对象,按照随机数表法将研究对象分为对照组(C组)以及试验组(D组),每组老年患者为30例。在全身麻醉诱导插管之后,D组经静脉给予右美托咪定0.05μg/(kg·min)剂量持续泵入,10min后以0.5μg/(kg·h)剂量进行持续泵入维持。C组经静脉持续泵入等量生理盐水作为对比。气管插管后取患者平卧位5min(T0)、俯卧位后5min(T1)、俯卧位后1h(T2)、俯卧位后2h(T3),并且监测记录患者各个时刻呼气末二氧化碳分压(PETCO_2)、气道峰压(Ppeak)、动态肺顺应性(Cdyn)、静态肺顺应性(Cstat)、潮气量(VT)等数值。患者入室后在局麻下行桡动脉穿刺,分别在T0、T1、T2、T3时刻经桡动脉抽取患者动脉血进行血气分析,并且记录各个时刻患者血气值中二氧化碳分压(PaCO_2)以及动脉血氧分压(PaO_2),通过公式计算出肺泡-动脉血氧分压差(PA-aDO2)、呼吸指数(RI)以及氧合指数(OI)。将所有数据进行采用SPSS 21.0统计软件处理,研究经静脉给予右美托咪定对老年脊柱后入路手术患者肺功能各项指标的影响。结果:组间对比,两组患者在年龄、性别、身体质量指数(BMI)基础资料方面对比无统计学差异。将实验患者由平卧位调整成为俯卧位后,呼吸力学指标比较,组内对比,在T0与T1、T2、T3时刻对比,T1、T2、T3时刻Cdyn、Cstat指标较低有统计学意义(P0.05),Ppeak指标有所升高有统计学意义(P0.05)。组间对比,在T3时刻C组Cdyn、Cstat指标比D组都有所降低有统计学意义(P0.05),Ppeak指标C组比D组增加更为明显有统计学意义(P0.05)。血气指标比较,组内对比,在T0与T2、T3时刻对比,T2、T3时刻OI指标较低有统计学意义(P0.05),PA-aO2、RI指标较高有统计学意义(P0.05)。组间对比,在T3时刻C组与D组对比,C组OI指标比D组都有所降低有统计学意义(P0.05),而P_(A-a)O_2、RI此项指标C组比D组增加更为明显有统计学意义(P0.05)。在整个手术阶段组间对比,两组患者在手术过程中VT、PETCO_2、手术时间、出血量对比无统计学差异。结论:通过组间对比结果显示,在全身麻醉状态下进行脊柱后入路手术的老年患者中,术中通过静脉给予右美托咪定可以明显改善老年患者肺功能,对肺功能起到保护性的作用。通过组内对比结果显示长时间的俯卧位脊柱手术,应注意对患者肺功能的保护,加强监测患者围术期肺功能各项指标,防止术后肺部并发症的发生。
[Abstract]:Objective: to investigate the effects of intravenous dexmetomidine on pulmonary function in elderly patients undergoing posterior spinal approach under general anesthesia. Methods: sixty elderly patients who underwent spinal posterior approach in Laoshan Hospital affiliated to Qingdao University were selected as experimental subjects. According to the random number method, the subjects were divided into control group C (n = 30) and group D (n = 30). After induction and intubation of general anesthesia, group D received dexmetomidine (0. 05 渭 g/(kg / min) continuously for 10 minutes and then sustained pump (0. 5 渭 g/(kg / h). Group C was continuously pumped into the same amount of normal saline through vein as a comparison. After endotracheal intubation, the patients were taken from the supine position for 5 min, the prone position for 5 min, the supine position for 1 h, and the supine position for 2 h, and the values of PETCO _ 2, peak airway pressure, dynamic lung compliance, static lung compliance, tidal volume and VT were monitored and recorded. After entering the room, the patients underwent radial artery puncture under local anesthesia. The arterial blood was extracted from the patients by the radial artery at the time of T0 T 1 and T 2 T 3 for blood gas analysis. Paco _ 2) and Pao _ 2s were recorded at each time. The alveolar-arterial oxygen pressure difference (PA-aDO2), respiratory index (RI) and oxygenation index (Oi) were calculated by formula. All the data were processed by SPSS21.0 statistical software to study the effects of intravenous dexmetomidine on pulmonary function in elderly patients undergoing posterior spinal approach. Results: there was no significant difference in basic data of age, sex and BMI between the two groups. After the patients were adjusted from supine position to prone position, the indexes of respiratory mechanics and intragroup comparison were compared, and the Cdynntam Cstat index was significantly lower at T0 and T1T2T2T 3 time than that at T1 T 2 + T 2 + T 3 time. There was a significant increase in P0.05 and Ppeak index (P 0.05). Compared with group D at T3, the Cdynnnnncstat index in group C was significantly lower than that in group D. There was significant difference between group C and group D in the increase of Cdynng and Cstat in group C (P 0.05) compared with that in group D (P 0.05). Compared with T0 and T2T 3, the OI of T 2 T 3 was lower than that of P 0 05 P 0 05 and PA-aO 2 O 2 RI was higher than that of T 2 O 2 T 3. There was a significant difference in P 0 05 between T 0 and T 2 T 3 and T 2 O 2 T 3 compared with T 0 and T 2 T 3. Compared with group D, the OI index of group C was significantly lower than that of group D at T3 time, while the index of P _ (A) A _ (A) O _ (2) RI in group C was significantly higher than that of group D (P _ (0.05) ~ 0. 05%), while that of group C was significantly lower than that of group D (P < 0. 05%), and that of group C was significantly higher than that of group D (P < 0. 05). There was no significant difference in the time of operation and the amount of blood loss between the two groups during the operation. Conclusion: the results of comparison between groups showed that intravenous dexmetomidine could significantly improve pulmonary function in elderly patients undergoing spinal posterior approach under general anesthesia. It has protective effect on lung function. According to the results of intra-group comparison, we should pay attention to the protection of pulmonary function, strengthen the monitoring of the indexes of pulmonary function in perioperative period, and prevent the occurrence of postoperative pulmonary complications.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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