CAJ | 학술논문

目的评价右美托咪定对脓毒症患者全麻时肺保护作用.方法脓毒症患者50例,拟在全麻下行急诊手术,年龄50 ～ 64岁,体重50～ 75 kg,ASA分级Ⅲ或Ⅳ级.采用随机数字表法,将患者分为2组(n=25):对照组(C组)和右美托咪定组(D组).D组常规麻醉诱导前经10 min静脉输注右美托咪定1.0 μg/kg,随后以0.4 μg·kg-1·h-1速率静脉输注2h,C组给予等容量生理盐水.常规麻醉诱导后气管插管,机械通气.麻醉维持:静脉输注瑞芬太尼0.08～0.20 μg·kg-1·min-1、异丙酚2～5 mg· kg-1·h-1,间断静脉注射顺阿曲库铵0.05 mg/kg,维持BIS值40～60.分别于切皮前即刻、切皮开始后2h、术后24 h时采集桡动脉血样和颈内静脉血样,进行动脉血气分析,计算氧合指数,测定静脉血血清降钙素原、TNF-α和IL-6的浓度.结果与C组比较,D组氧合指数升高,血清降钙素原、TNF-α和IL-6的浓度降低,肺功能改善率升高(P＜0.05).结论常规麻醉诱导前静脉输注右美托咪定1.0 μg/kg,随后以0.4 μg· kg-1·h-1速率输注2h对脓毒症患者全麻时具有肺保护作用.
목적 평개우미탁미정대농독증환자전마시폐보호작용.방법 농독증환자50례,의재전마하행급진수술,년령50 ～ 64세,체중50～ 75 kg,ASA분급Ⅲ혹Ⅳ급.채용수궤수자표법,장환자분위2조(n=25):대조조(C조)화우미탁미정조(D조).D조상규마취유도전경10 min정맥수주우미탁미정1.0 μg/kg,수후이0.4 μg·kg-1·h-1속솔정맥수주2h,C조급여등용량생리염수.상규마취유도후기관삽관,궤계통기.마취유지:정맥수주서분태니0.08～0.20 μg·kg-1·min-1、이병분2～5 mg· kg-1·h-1,간단정맥주사순아곡고안0.05 mg/kg,유지BIS치40～60.분별우절피전즉각、절피개시후2h、술후24 h시채집뇨동맥혈양화경내정맥혈양,진행동맥혈기분석,계산양합지수,측정정맥혈혈청강개소원、TNF-α화IL-6적농도.결과 여C조비교,D조양합지수승고,혈청강개소원、TNF-α화IL-6적농도강저,폐공능개선솔승고(P＜0.05).결론 상규마취유도전정맥수주우미탁미정1.0 μg/kg,수후이0.4 μg· kg-1·h-1속솔수주2h대농독증환자전마시구유폐보호작용.
Objective To evaluate pulmonary protection of dexmedetomidine under general anesthesia in the patients with sepsis.Methods Fifty patients with sepsis,aged 50-64 yr,weighing 50-75 kg,of ASA physical status Ⅲ or Ⅳ,were randomly divided into 2 groups (n =25 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium,and maintained with infusion of remifentanil and propofol and intermittent iv boluses of cisatracurium.The patients were endotracheally intubated and mechanically ventilated.In group D,dexmedetomidine 1.0 μg/kg was infused over 10 min,followed by infusion at 0.4 μg · kg-1 · h-1 for 2 h before induction of anesthesia.While the equal volume of normal saline was given in group C.BIS value was maintained at 40-60.Immediately before skin incision,at 2 h after beginning of skin incision,and at 24 h after operation,arterial and venous blood samples were taken for blood gas analysis and for determination of the concentrations of serum procalitonin,interleukin-6 and tumor necrosis factor-alpha.Oxygenation index was calculated.Results Compared with group C,oxygenation index was significantly increased,the concentrations of serum procalitonin,tumor necrosis factor-alpha and interleukin-6 were decreased,and the rate of improvement of pulmonary function was increased in group D.Conclusion Dexmedetomidine (infusion at 0.4 pg · kg-1 · h 1 for 2 h after infusion of 1.0 μg/kg) before induction of anesthesia provides pulmonary protection under general anesthesia in the patients with sepsis.