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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
薛海锋,吕洁萍.右美托咪定联合七氟醚对体外循环手术患者肺损伤的影响[J].中华老年多器官疾病杂志,2019,18(9):641~645
右美托咪定联合七氟醚对体外循环手术患者肺损伤的影响
Effects of dexmedetomidine combined with sevoflurane on lung injury in patients undergoing cardiopulmonary bypass
投稿时间:2019-04-03  
DOI:10.11915/j.issn.1671-5403.2019.09.139
中文关键词:  体外循环;七氟醚;右美托咪定;肺损伤
英文关键词:cardiopulmonary bypass; sevoflurane; dexmedetomidine; lung injury
基金项目:山西省自然科学基金(201601D102068)
作者单位E-mail
薛海锋 山西医科大学麻醉学系,太原 030001  
吕洁萍 山西医科大学第一医院麻醉科,太原 030001 861609851@qq.com 
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中文摘要:
      目的 探讨右美托咪定联合七氟醚对体外循环患者肺损伤的影响。方法 择期行体外循环下心脏瓣膜置换术患者80例,随机数表法分为4组:右美托咪定组(D组)、七氟醚组(S组)、右美托咪定联合七氟醚组(DS组)和对照组(C组),每组各20例。D组和DS组在麻醉诱导前10min内泵注0.8μg/kg负荷剂量的右美托咪定,术中继续以0.6μg/(kg·h)持续泵注到手术结束。S组和DS组分别在阻断升主动脉前、阻断升主动脉后、开放升主动脉前和开放升主动脉后各吸入2%的七氟醚15min。分别记录麻醉诱导前(T1)、体外循环后即刻(T2)、手术结束后(T3)、术后1d(T4)的氧合指数(OI)、肺泡-动脉氧分压差[P(A-a)O2]、肺静态顺应性(Cst)、可溶性细胞间黏附分子-1(sICAM-1)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)等水平。采用SPSS 21.0软件进行数据处理。结果 在T2~T4期,C组患者的TNF-α、IL-8、sICAM-1浓度高于其他3组(P<0.05),DS组患者的TNF-α、IL-8、sICAM-1浓度低于D组和S组(P<0.05)。在T2~T4期,C组患者的P(A-a)O2高于其他3组(P<0.05),OI、Cst低于其他3组(P<0.05);DS组患者的P(A-a)O2低于D组和S组(P<0.05),OI、Cst高于D组和S组(P<0.05)。结论 七氟醚联合右美托咪定的麻醉方法能减轻体外循环肺损伤程度,且效果优于七氟醚、右美托咪定单独的复合麻醉。
英文摘要:
      Objective To investigate the effect of dexmedetomidine combined with sevoflurane on lung injury in the patients undergoing cardiopulmonary bypass. Methods A total of 80 patients scheduled for heart valve replacement under cardiopulmonary bypass were recruited and randomly divided into 4 groups (n=20):dexmedetomidine group (D group), sevoflurane group (S group), dexmedetomidine combined with sevoflurane group (DS group) and control group. For the patients of groups D and DS, dexmedetomidine were continuously pumped into vein with the loading dose of 0.8μg/kg 10 min before introduction of general anesthesia, and then the speed was adjusted to 0.6μg/(kg·h) to the end of surgery. For those from groups S and DS, 2% sevoflurane was inhaled for 15min before and after the ascending aorta was blocked, and also before and after the ascending aorta was opened. Oxygenation index (OI), alveolar-arterial oxygen partial pressure difference [P(A-a)O2], static compliance (Cst), and plasma levels of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) were recorded and measured before anesthesia induction (T1), immediately after cardiopulmonary bypass (T2), after surgery (T3), and 1 d after surgery (T4). SPSS statistics 21.0 was used to perform the statistical analysis. Results The plasma levels of TNF-α, IL-8 and sICAM-1 in control group were the highest when compared with those in the other 3 groups at T2-T4 (P<0.05), and the levels was significantly lower in DS group than those of D group and S group at T2-T4 (P<0.05). At the time period, the P(A-a)O2 was significantly higher while the OI and Cst were obviously lower in control group than in the other 3 groups (P<0.05). And the P(A-a)O2 of DS group was significantly lower than that of the D group and S group (P<0.05), and OI and Cst were notably higher than those of the D group and S group (P<0.05). Conclusion Sevoflurane combined with dexmedetomidine can alleviate lung injury in the patients undergoing cardiopulmonary bypass, and the effect is better than the combined anesthesia of sevoflurane and dexmedetomidine alone.
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