右美托咪定对肺癌术后患者微循环的影响

Effect of Dexmedetomidine on microcirculation of lung cancer patients after operation

摘要:

目的观察2 种剂量右美托咪定（Dex）对肺癌根治术后机械通气患者微循环的影响。方法选取肺癌术后入重症监护室行机械通气的患者60 例，按随机数字表法分为A、B 两组，每组30 例，分别静脉微泵0.6 和0.8μg/（kg·h）剂量的Dex。观察并记录给药前（T0）和给药后15 min（T1）、30 min（T2）、1 h（T3）、2 h（T4）的心率（HR）、收缩压（SBP）、舒张压（DBP）、心输出量（CO）、经皮氧分压（TcPO2）、经皮二氧化碳分压（TcPCO2）、氧分压（PaO2）、二氧化碳分压（PaCO2）及血乳酸（Lac）值。记录心血管不良事件的发生情况。结果两组不同时间血流动力学指标有差异，均呈下降趋势，以B 组更明显，两组组间各指标比较，差异无统计学意义（p >0.05）；两组不同时间PaO2、PaCO2及TcPCO2比较，差异无统计学意义（p >0.05）；两组不同时间Lac 比较，差异有统计学意义（p <0.05），呈上升趋势。两组不同时间TcPO2比较，差异有统计学意义（ <0.05），两组给药后变化趋势比较，差异有统计学意义（p <0.05），两组TcPO2均较用药前升高。结论0.6μg/（kg·h）Dex 泵注肺癌术后机械通气患者，血流动力学更稳定，微循环改善更显著。

Abstract:

Objective To investigate effect of two doses of Dexmedetomidine (Dex) on cardiac output and microcirculation in patients with mechanical ventilation after radical resection of lung cancer. Methods A total of 60 patients who were treated in the Intensive Care Unit after lung surgery were included. The patients were randomly devided into two groups with 30 people in each. Dex was infused in a dose of 0.6 μg/(kg·h) (group A) or 0.8 μg/(kg·h) (group B). The values of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiac output (CO), transcutaneous oxygen pressure (TcPO2), transcutaneous carbon dioxide pressure (TcPCO2), PaO2, PaCO2 and Lac were recorded before (T0), 15 min (T1), 30 min (T2), 1 h (T3),and 2 h (T4) after continuous intravenous infusion of the drugs. Cardiovascular adverse events were recorded. Results There were significant differences in the hemodynamic indexes at different time points in both groups,the indices showed descending trends which were more obvious in the group B. However, there were no significant differences in the indexes between the two groups. There were no significant differences in PaO2,PaCO2 or TcPCO2 between the two groups at different time points. There were differeces in Lac between the two groups at different time points (p < 0.05) with an upward trend in each group. There were differeces in TcPO2 between the groups A and B at different time points (p < 0.05) and the change trends of the two groups after drug administration were different (p < 0.05). TcPO2 increased in the two groups after infusion. Conclusions In the dose of 0.6 μg/(kg·h) Dexmedetomidine infusion, hemodynamics change little while microcirculation is effectively improved in the mechanically ventilated patients after radical resection of lung cancer.