CAJ | 학술논문

目的为了观察预注右美托咪啶对老年肺癌患者插入双腔气管导管(DLT)诱发心血管反应的影响.方法选择60例年龄65～80岁,体重45～75 kg,ASA Ⅰ～Ⅱ级择期行肺癌手术的患者,随机分为右旋美托咪啶组(D组)和对照组(C组),每组30例.D组右旋美托咪啶1μg/kg,用生理盐水配制成4 μg/L的浓度,麻醉前15min内静脉注射完毕.C组持续输注同等容量生理盐水作对照.麻醉诱导:静脉注射芬太尼4μ g/kg,依托咪酯0.3 mg/kg,顺阿曲库铵0.15 mg/kg,给完药后4分钟行双腔支气管插管,成功后接麻醉机行机械通气.观察患者输注右美托咪啶前(T0),泵注右美托咪啶或生理盐水结束时(T1)、气管插管前(T2)、气管插管即刻(T3)、气管插管后1 min(T4)、3 min(T5)及5min (T6)各时间点的动脉收缩压(SAP)、舒张压(DAP)、平均动脉压(MAP)、和心率(HR)的数值.结果两组间T0时SAP、DAP、MAP和HR相比差异无统计学意义(P＞0.05).T1和T2时,D组SAP、DAP、MAP均较C组升高(P＜0.05)；D组T1时HR比C组降低(P＜0.05).T3至T6时,D组患者的SAP、DAP、MAP和HR均比C组要低(P＜0.05).结论全麻诱导前静脉输注右美托咪啶可有效抑制老年肺癌患者双腔支气管插管诱发的心血管反应,维持血流动力学稳定.
목적 위료관찰예주우미탁미정대노년폐암환자삽입쌍강기관도관(DLT)유발심혈관반응적영향.방법 선택60례년령65～80세,체중45～75 kg,ASA Ⅰ～Ⅱ급택기행폐암수술적환자,수궤분위우선미탁미정조(D조)화대조조(C조),매조30례.D조우선미탁미정1μg/kg,용생리염수배제성4 μg/L적농도,마취전15min내정맥주사완필.C조지속수주동등용량생리염수작대조.마취유도:정맥주사분태니4μ g/kg,의탁미지0.3 mg/kg,순아곡고안0.15 mg/kg,급완약후4분종행쌍강지기관삽관,성공후접마취궤행궤계통기.관찰환자수주우미탁미정전(T0),빙주우미탁미정혹생리염수결속시(T1)、기관삽관전(T2)、기관삽관즉각(T3)、기관삽관후1 min(T4)、3 min(T5)급5min (T6)각시간점적동맥수축압(SAP)、서장압(DAP)、평균동맥압(MAP)、화심솔(HR)적수치.결과 량조간T0시SAP、DAP、MAP화HR상비차이무통계학의의(P＞0.05).T1화T2시,D조SAP、DAP、MAP균교C조승고(P＜0.05)；D조T1시HR비C조강저(P＜0.05).T3지T6시,D조환자적SAP、DAP、MAP화HR균비C조요저(P＜0.05).결론 전마유도전정맥수주우미탁미정가유효억제노년폐암환자쌍강지기관삽관유발적심혈관반응,유지혈류동역학은정.
Objective To explore the effect of dexmedetomidine on cardiovascular response to intubation of double lumen tube in elderly patients with lung cancer.Methods 60 patients aged 65-80 years,weighing 45-75 kg,ASA Ⅰ or Ⅱ,scheduled for elective thoracic surgery were randomly assigned into dexmedetomidine group (group D,n=30) and controlled group (group C,n=30).In group D,dexmedetomidine 1 μ g/kg was infused by syringe pump for 15 min while equal volume of normal saline was given in group C before induction.Anesthesia was induced with fentanyl 4 μ g/kg,etomidate 0.3 mg/kg and atracuruim 0.15 mg/kg.After bronchial intubation was performed,the patients were mechanically ventilated.Systolic and diastolic arterial pressure (SAP,DAP),mean arterial pressure (MAP) and heart rate (HR) were recorded before infusion (T0),ending of infusing dexmedetomidine or normal saline (T1),before bronchial intubation (T2),instance of bronchial intubation (T3),1min,3min and 5min after bronchial intubation (T4-6).Results There was no significant difference of SAP,DAP,MAP and HR at T0 between the two groups (P ＞ 0.05).Compared with group C,SAP,DAP,MAP and HR at T1 and T2 in group D were significantly increased.HR at T1 in group D was obviously lower than that of group C (P ＜ 0.05).At T3-6,SAP,DAP,MAP and HR in group D were significantly lower than those in group C (P ＜ 0.05).Conclusion Intravenous infusing dexmedetomidine before induction of general anesthesia can effectively inhibit the cardiovascular response caused by bronchial intubation in elderly patients with lung cancer and maintain the stability of hemodynamics.