| 林奕彬,舒海华,叶 芳,曾志文,廖亿粦,常 路.不同剂量右美托嘧啶对胸腔镜下食管癌根治术患者心肌氧供及血流动力学的影响[J].,2017,17(4):692-695 |
| 不同剂量右美托嘧啶对胸腔镜下食管癌根治术患者心肌氧供及血流动力学的影响 |
| The Effects of Dexmedetomidine of Two Different Dose Infusion on Myocardial Oxygen Supply and Hemodynamics in Patients with Radical Resection of Esophageal Carcinoma under Thoracoscopy Surgery |
| 投稿时间：2016-06-14 修订日期：2016-07-10 |
| DOI：10.13241/j.cnki.pmb.2017.04.023 |
| 中文关键词: 右美托嘧啶 剂量 食管癌根治术患者 心肌氧供 血流动力学 |
| 英文关键词: Dexmedetomidine Dose Patients with radical resection of esophageal carcinoma under thoracosocopy surgery Myocardial oxygen supply Hemodynamics |
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| 中文摘要: |
| 摘要 目的：探讨不同剂量右美托嘧啶(DEX)对胸腔镜下食管癌根治术患者心肌氧供及血流动力学的影响。方法：选取66例我院拟行腔镜下食管癌根治术患者，随机分为三组，每组各22例：低剂量右美托嘧啶组（L组）(0.5 μg/kg)、高剂量右美托嘧啶组（H组）（1.0 μg/kg）、对照组（N组）（与L组和H组同等速率输注生理盐水），而后H组和L组均以0.5 μg/kg/h维持输注DEX。记录各组输注前（T1）、输注后5 min（T2）、输注后10 min （T3）、输注后15 min（T4）、输注后30 min（T5）各组血流动力学指标：心率（HR）、收缩压（SBP）、平均动脉压（MAP）、每搏输出量（SV）、中心静脉压（CVP）、心排量（CO），计算HR与SBP的乘积RPP，抽取挠动脉和肺动脉血进行动脉血气分析，采用反向FICK法计算氧供（DO2）和氧耗（VO2）。结果：HR：H组和L组患者HR随时间的推移呈下降趋势，H 组T3、T4、T5时间点HR较T1时间点显著降低（P<0.05）；与N组相比，H组和L组T3、T4、T5时间点HR显著降低（P<0.05）。MAP：H组T3、T4、T5时间点MAP显著低于L组（P<0.05）；H组T3、T4时间点MAP显著低于N组（P<0.05）；H组T5时间点MAP显著低于同组T1、T2时间点（P<0.05）。SBP：H组T3、T4、T5时间点SBP与L组和N组比较显著降低（P<0.05）；H组T5时间点SBP较同组T1、T2时间点显著降低（P<0.05）。RPP：H组T3、T4、T5时间点RPP与同组T1、T2时间点和N组比较显著降低（P<0.05）。DO2：H组T5时间点DO2与L组和N组比较显著降低（P<0.05）。VO2：L组患者VO2 T3、T4、T5时间点与组内T1、T2时间点和N组相比显著降低（P<0.05）；H组VO2 T3、T4、T5时间点与组内T1、T2时间点和N组相比显著降低（P<0.05）。结论：小剂量（0.5 μg/kg）输注DEX能降低胸腔镜下食管癌患者心肌氧耗，维持血流动力学稳定，高剂量（1.0 μg/kg）输注DEX降低心肌氧耗的同时会降低心肌氧供，存在一定风险，对于患有冠心病以及心肺功能低下的老年患者，建议给予小剂量输注DEX，并监测血流动力学指标，及时调整DEX用量。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effects of dexmedetomidine of two different dose infusion on myocardial oxygen supply and hemodynamics in patients with radical resection of esophageal carcinoma under thoracoscopy surgery. Methods: 66 cases with radical resection of esophageal carcinoma under thoracoscopy surgery in our hospital were enrolled in the study. These patients were randomly divided into three groups, there were 22 people in each group: Low dose dexmedetomidine group(Group L)(0.5 μg/kg), High dose dexmedetomidine group(Group H)(1.0 μg/kg) and Normal saline(Group N)(infusing physiological saline at the same rate of Group L and Group H). Then the same rate of maintecance infusing DEX of group H and L was 0.5 μg/kg/h. Hemodynamic index incloding: HR, SBP,MAP, SV, CVP, CO, HR×SBP(RPP), pulmonary blood gas analysis, oxygen supply(DO2)and oxygen consumption(VO2) at five time points were recorded: before DEX and physiological saline infusion(T1), infusion 5 min later(T2), DEX and infusion 10 min later(T3), infusion 15 min later(T4), infusion 30 min later(T5). Results: HR of group H and L patients showed up a depression trend; In Group H, compared with T1 time point, HR of T3, T4 and T5 time points reduced significantly(P<0.05); Compared with Group N, HR of the group H and L T3,T4 and T5 time points reduced significantly(P<0.05). Compared with Group L, MAP of group H T3, T4 and T5 time points reduced significantly(P<0.05); Compared with Group N, MAP of the group H T3, T4 and T5 time points reduced significantly(P<0.05); Compared with T1, T2 time points in Group H, MAP of T5 time points reduced significantly(P<0.05) Compared with Group L and Group N, SBP of group H T3, T4 and T5 time points reduced significantly(P<0.05); Compared with T1, T2 points in Group H, SBP of T5 time points reduced significantly (P<0.05); Compared with T1,T2 time points in Group H and Group N, RPP of T3, T4, T5 time points in Group H reduced significantly(P<0.05). Compared with Group L and Group N, DO2 of T5 time points in Group H reduced significantly(P<0.05); Compared with T1, T2 time points in Group L and Group N, VO2 of T3, T4, T5 time points in Group L reduced significantly(P<0.05); Compared with T1, T2 time points in Group H and Group N, VO2 of T3, T4, T5 time points in Group H reduced significantly(P<0.05). Conclusion: Low dose DEX infusion(0.5 μg/kg) could reduce myocardial oxygen consumption of patients with radical resection of esophageal carcinoma under thoracoscopy surgery and maintain hemodynamic stability, high dose DEX infusion (1.0 μg/kg) could reduce myocardial oxygen consumption, which could reduced myocardial oxygen supply at the same time, there is a risk. For elderly patients with coronary heart disease and low cardiopulmonary function, low doses DEX infusion was suggested, and monitoring hemodynamic parameters, adjust the dose of DEX timely. |
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