CAJ | 학술논문

目的探讨右美托咪定对开胸手术患者围术期末梢灌注指数(TPI)和心率变异性(HRV)的影响.方法择期行肺癌根治术患者30例,ASA分级Ⅰ级或Ⅱ级,年龄40 ～ 70岁,体重38～80 kg,采用随机数字表法,将其分为2组(n=15):对照组(C组)和右美托咪定组(D组).C组静脉注射生理盐水20 ml,D组静脉注射右美托咪定1μg/kg(20 ml).麻醉诱导:TCI异丙酚,血浆靶浓度4μg/ml,静脉注射芬太尼5 μg/kg(C组)或3 μg/kg(D组)和罗库溴铵0.9 mg/kg.气管插管后行机械通气,维持PETCO2 35～ 45 mm Hg.麻醉维持:D组TCI异丙酚,血浆靶浓度4 μg/ml,静脉输注右美托咪定0.5 μg·kg-1 ·h-1,必要时静脉注射芬太尼0.1 mg;C组TCI异丙酚,血浆靶浓度4 μg/ml,间断静脉注射芬太尼0.1 mg.分别于麻醉诱导前(T0)、气管插管前即刻(T1)、气管插管后即刻(T2)、切皮即刻(T3)、胸骨撑开即刻(T4)、开胸后30 min(T5)、1 h(T6)和术毕(T7)时,记录TPI、低频功率(LF)和高频功率(HF),计算LF与HF的比值(LF/HF).记录心血管事件的发生情况.结果与C组比较,D组B-7时TPI值升高,T4-6时LF/HF降低,高血压发生率降低(P＜0.05).结论右美托咪定可通过降低交感神经张力,改善开胸手术患者微循环.
목적 탐토우미탁미정대개흉수술환자위술기말소관주지수(TPI)화심솔변이성(HRV)적영향.방법 택기행폐암근치술환자30례,ASA분급Ⅰ급혹Ⅱ급,년령40 ～ 70세,체중38～80 kg,채용수궤수자표법,장기분위2조(n=15):대조조(C조)화우미탁미정조(D조).C조정맥주사생리염수20 ml,D조정맥주사우미탁미정1μg/kg(20 ml).마취유도:TCI이병분,혈장파농도4μg/ml,정맥주사분태니5 μg/kg(C조)혹3 μg/kg(D조)화라고추안0.9 mg/kg.기관삽관후행궤계통기,유지PETCO2 35～ 45 mm Hg.마취유지:D조TCI이병분,혈장파농도4 μg/ml,정맥수주우미탁미정0.5 μg·kg-1 ·h-1,필요시정맥주사분태니0.1 mg;C조TCI이병분,혈장파농도4 μg/ml,간단정맥주사분태니0.1 mg.분별우마취유도전(T0)、기관삽관전즉각(T1)、기관삽관후즉각(T2)、절피즉각(T3)、흉골탱개즉각(T4)、개흉후30 min(T5)、1 h(T6)화술필(T7)시,기록TPI、저빈공솔(LF)화고빈공솔(HF),계산LF여HF적비치(LF/HF).기록심혈관사건적발생정황.결과 여C조비교,D조B-7시TPI치승고,T4-6시LF/HF강저,고혈압발생솔강저(P＜0.05).결론 우미탁미정가통과강저교감신경장력,개선개흉수술환자미순배.
Objective To investigate the effects of dexmedetomidine on perioperative tip perfusion index (TPI) and heart rate variability (HRV) in patients undergoing thoracic surgery.Methods Thirty ASA physical status Ⅰ or Ⅱ patients,aged 40-70 yr,weighing 38-80 kg,scheduled for elective radical operations for lung cancer,were randomly divided into 2 groups (n =15 each):control group (group C) and dexmedetomidine group (group D).Normal saline 20 ml was injected intravenously in group C,while dexmedetodine 1 μg/kg (20 ml) was injected intravenously in group D.Anesthesia was induced with target-controlled infusion (TCI) of propofol with the target plasma concentration (Cp) of 4 μg/ml,and iv injection of fentanyl 5 μg/kg (in group C) or 3 μg/kg (in group D) and rocuronium 0.9 mg/kg.When BIS value decreased to 50,a double lumen endobronchial tube was inserted.The patients were mechanically ventilated and PETCO2 was maintained at 35-45 mm Hg.Anesthesia was maintained with TCI of propofol with the Cp of 4 μg/ml,infusion of dexmedetodine 0.5 μg· kg-1 · h-1,and injection of fentanyl 0.1 mg when needed in group D,or with TCI of propofol with the Cp of 4μg/ml and intermittent iv boluses of fentanyl 0.1 mg in group C.Before induction (T0),immediately before and after intubation (T1,2),immediately after skin incision (T3),immediately after splitting of sternum (T4),at 30 min and 1 h after chest opening (T5,6),and at the end of operation (T7),TPI,low frequency power (LF) and high frequency power (HF)were recorded,and LF/HF ratio was calculated.The development of cardiovascular events was recorded.Results Compared with group C,TPI at T3-7 was significantly increased,LF/HF ratio at T4-6 was decreased,and the incidence of hypertension was decreased in group D (P ＜ 0.05).Conclusion Dexmedetomidine can improve microcirculation through decreasing sympathetic activity in patients undergoing thoracic surgery.