CAJ | 학술논문

目的观察右美托咪定( Dex)对食管癌手术中单肺通气( OLV)肺内分流和动脉氧分压( PaO2)的影响。方法40例择期行左经胸食管癌根治术患者,美国麻醉医师协会( ASA)分级Ⅰ~Ⅱ级,年龄25~65(57.2±8.5)岁,术前检查心肺功能良好,随机分为2组(每组20例)：Dex组和生理盐水(NS)组,Dex组麻醉诱导给予Dex负荷量0.6μg/kg,给药时间10 min,0.4μg/( kg·h)维持至手术结束前30 min；NS组：给于等量生理盐水泵注。采集麻醉诱导后侧卧位双肺通气30 min( T1)、OLV 30 min( T2)、OLV 60 min( T3)、OLV 90 min(T4)、恢复双肺通气(TLV)30 min(T5)时桡动脉和颈内静脉血进行血气分析,根据血气值计算肺内分流率( Qs/Qt),记录PaO2值。结果两组血流动力学指标平均动脉压( MAP)和脑电双频指数( BIS)比较差异无统计学意义( P>0.05)。与T1时比,两组T2~4时PaO2显著降低,Qs/Qt显著升高(P<0.05)；与T1时比,NS组T5时PaO2显著降低,Qs/Qt显著升高(P<0.05),Dex组T5时PaO2和Qs/Qt差异无统计学意义(P>0.05)；与NS组比,Dex组T5时PaO2升高, Qs/Qt降低(P<0.05)。结论 Dex在食管癌手术患者中能明显改善恢复TLV后PaO2及Qs/Qt。
목적관찰우미탁미정( Dex)대식관암수술중단폐통기( OLV)폐내분류화동맥양분압( PaO2)적영향。방법40례택기행좌경흉식관암근치술환자,미국마취의사협회( ASA)분급Ⅰ~Ⅱ급,년령25~65(57.2±8.5)세,술전검사심폐공능량호,수궤분위2조(매조20례)：Dex조화생리염수(NS)조,Dex조마취유도급여Dex부하량0.6μg/kg,급약시간10 min,0.4μg/( kg·h)유지지수술결속전30 min；NS조：급우등량생리염수빙주。채집마취유도후측와위쌍폐통기30 min( T1)、OLV 30 min( T2)、OLV 60 min( T3)、OLV 90 min(T4)、회복쌍폐통기(TLV)30 min(T5)시뇨동맥화경내정맥혈진행혈기분석,근거혈기치계산폐내분류솔( Qs/Qt),기록PaO2치。결과량조혈류동역학지표평균동맥압( MAP)화뇌전쌍빈지수( BIS)비교차이무통계학의의( P>0.05)。여T1시비,량조T2~4시PaO2현저강저,Qs/Qt현저승고(P<0.05)；여T1시비,NS조T5시PaO2현저강저,Qs/Qt현저승고(P<0.05),Dex조T5시PaO2화Qs/Qt차이무통계학의의(P>0.05)；여NS조비,Dex조T5시PaO2승고, Qs/Qt강저(P<0.05)。결론 Dex재식관암수술환자중능명현개선회복TLV후PaO2급Qs/Qt。
Objective To observe the effects of dexmetomidine on OLV intrapulmonary shunt in and oxygen pres-sure of the artery during one-lung ventilation undergoing esophageal cancer resection. Methods A total of 40 pa-tients of ASA Ⅰ or II,aged 25~65 undergoing elective surgery were randomized into two groups of 20 each. Dex group and normal saline (NS) group. Dex group used Dex 0. 6 μg/kg within 10 min as a bolus and then main-tained at 0.4 μg/( kg·h) ,before the end of the operation 30 min. The same volume of NS was given in the same manner in NS group. Radial artery and internal jugular vein blood were collected and the blood gas were analyzed at five time points:after anesthesia induction at lateral position TLV 30 min( T1 ) ,OLV 30 min( T2 ) ,OLV 60 min ( T3 ) ,OLV 90 min( T4 ) ,recovering TLV 30 min( T5 ) ,and then calculating the intrapulmonary shunt and recorded oxygen pressure of the artery. Results There were no significant differences in hemodynamic parameters MAP and BIS between the two groups(P>0.05). PaO2 was significantly lower, while Qs/Qt was higher at T2~4 than at T1 in group Dex and NS(P<0.05);PaO2 was lower,while Qs/Qt was higher at T5 than at T1 in group NS(P<0.05);but there were no statistical differences in group Dex (P>0.05). PaO2 was higher,while Qs/Qt was lower at T5 in group Dex than in group NS ( P<0.05 ) . Conclusion Dex can improve intrapulmonary shunt and oxygen pressure of the artery significantly in esophageal cancer resection after recovering TLV.