标题：右美托咪定对体外循环手术患者的肺保护作用

      作者：米颖，秦再生，欧阳铭文
    (南方医科大学南方医院麻醉科，广东 广州 510515)

      卷次： 2016年27卷17期

      【摘要】 目的 探讨右美托咪定在体外循环手术中对肺的保护作用。方法 选取2013年1月至2015年11月
在我院心胸外科择期全麻下行心脏瓣膜置换术的患者86例，随机分为观察组和对照组各43例。两组患者均采用
相同的麻醉方法，在麻醉开始诱导前10 min，观察组在对照组基础上，静脉持续泵入负荷剂量右美托咪定0.8 μg/kg，
后以 0.6 μg/(kg·h)的速度维持至术毕。分别对麻醉诱导前(T0)、CPB前(T1)、术毕关胸后 5 min (T2)、术后 12 h
(T3)、术后 48 h (T4)采集两组患者的动脉血4 mL进行血气分析并计算肺泡-动脉氧分压差(AaDO2)、氧合指数(OI)、
呼吸指数(RI)，同时测定血清中SP-A、TNF-α、IL-6的水平。结果 两组患者的性别、年龄、体重、手术类型、体外循
环时间、主动脉阻断时间等方面比较差异均无统计学意义(P>0.05)；观察组患者术后机械通气时间和 ICU停留时间
低于对照组(P<0.05)。两组患者各时间点与 T0比，T2、T3时AaDO2、RI均升高(P<0.05)，T1、T2时OI均下降(P<
0.05)，T4时差异无统计学意义(P>0.05)，观察组AaDO2、RI在T2、T3时低于对照组(P<0.05)，观察组的OI在T2、T3
时高于对照组(P<0.05)。两组患者各时间点与T0比，T1时SP-A、TNF-α、IL-6差异无统计学意义(P>0.05)，T2、T3
时SP-A、TNF-α、IL-6水平均升高(P<0.05)，观察组SP-A、TNF-α、IL-6在T2、T3时低于对照组(P<0.05)。结论 体
外循环手术中给予右美托咪定进行药物干预，能够有效抑制炎症反应，改善患者的肺功能，降低急性肺损伤的发生
率，加快心脏手术患者术后转归。

      【关键词】 体外循环；肺保护；右美托咪定；麻醉；炎症

      【中图分类号】 R65 【文献标识码】 A 【文章编号】 1003—6350（2016）17—2786—05


Lung-protective effects of dexmedetomidine among patients receiving cardiopulmonary bypass surgery.
MI Ying,
QIN Zai-sheng, OUYANG Ming-wen. Department of Anesthesiology, Nanfang Hospital, Southern Medical University,
Guangzhou 510515, Guangdong, CHINA

【Abstract】 Objective To investigate the lung-protective effects of dexmedetomidine in cardiopulmonary by-
pass surgery. Methods Eighty-six patients receiving cardiac valve replacement under the general anesthesia in our hos-
pital from January 2013 to November 2015 were selected and randomly divided into observation group and control
group, with 43 patients for each group. Two groups had the same anesthesia methods. For the observation group, dexme-
detomidine were continuously pumped into vein with the loading dose of 0.8 μg/kg, ten minutes before introduction of
general anesthesia, and then the speed was adjusted to 0.6 μg/(kg·h) to the end of surgery. 4 mL-arterial-blood samples
were taken from each group to do the blood gas analysis and to get the value of alveolar-arterial oxygen difference (Aa-
DO2), oxygen composite index (OI) and respiratory index (RI) at different times of before induction of anesthesia (T0),
before cardiopulmonary bypass (T1), 5 min after sternal closure (T2), 12 h and 48 h after operation (T3, T4), while se-
rum concentrations of SP-A, TNF-α and IL-6 were tested at the same time. Results There was no significant differ-
ence of age, sex, body weight, type of operation, cardiopulmonary bypass time, aortic occlusion time and blood loss be-
tween the two groups (P>0.05). But the time of mechanical ventilation and the time of staying in ICU of the observation
group was obviously lower than the control group (P<0.05). Compared with T0 in the two groups, AaDO2, RI of T2 and
T3 showed a increasing trend (P<0.05), while OI of T1 and T2 showed a decreasing trend (P<0.05) and no significant
difference was found at T4 (P>0.05). Comparing the two groups, AaDO2, RI at T2, and T3 of the observation group was
lower than that of the control group (P<0.05), and OI at T2, and T3 of the observation group was higher than that of the
control group (P<0.05). Compared with T0 in the two groups, there was no significant difference of SP-A,TNF-α, IL-6
between T1 and T0, but SP-A, TNF-α, IL-6 of T2 and T3 showed a increasing trend (P<0.05) and SP-A, TNF-α, IL-6
at T2 and T3 of the observation group was significantly lower than that of the control group. Conclusion Dexmedeto-
midine given in the cardiopulmonary bypass operation can effectively inhibit inflammation response, improve lung
function, reduce the incidence of acute lung injury and speed up the postoperative outcome of patients undergoing car-
diac surgery.

      【Key words】 Cardiopulmonary bypass; Lung protection; Dexmedetomidine; Anesthesia; Inflammation
·论 著·
6350.2016.17.012