[1]张艳珂,赵志斌,张小宝,等.右美托咪定对行腹腔镜全子宫切除术患者肺功能的影响[J].新乡医学院学报,2022,39(8):721-725.[doi:10.7683/xxyxyxb.2022.08.004]
　ZHANG Yanke,ZHAO Zhibin,ZHANG Xiaobao,et al.Effect of dexmedetomidine on pulmonary function of patients undergoing laparoscopic hysterectomy[J].Journal of Xinxiang Medical University,2022,39(8):721-725.[doi:10.7683/xxyxyxb.2022.08.004]
点击复制

右美托咪定对行腹腔镜全子宫切除术患者肺功能的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年8
页码:
721-725
栏目:
临床研究
出版日期:
2022-08-05

文章信息/Info

Title:
Effect of dexmedetomidine on pulmonary function of patients undergoing laparoscopic hysterectomy
作者:
张艳珂1; 赵志斌1; 张小宝1; 王　云1; 桂文虎1; 张林娜2; 于凡珍3
（1.徐州医科大学附属连云港医院麻醉科，江苏　连云港　222000；2.徐州医科大学附属连云港医院妇科，江苏　连云港　222000；3.徐州医科大学附属连云港医院呼吸与重症医学科，江苏　连云港　222000）
Author(s):
ZHANG Yanke1; ZHAO Zhibin1; ZHANG Xiaobao1; WANG Yun1; GUI Wenhu1; ZHANG Linna2; YU Fanzhen3
(1.Department of Anesthesiology,the Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang 222000,Jangsu Province,China;2.Department of Gynecology,the Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang 222000,Jangsu Province,China;3.Department of Respiratory and Critical Care Medicine,the Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang 222000,Jangsu Province,China)
关键词:
右美托咪定; 全子宫切除术; 气道压：肺顺应性; 术后并发症
Keywords:
dexmedetomidine; hysterectomy; airway pressure; pulmonary compliance; postoperative complications
分类号:
R614
DOI:
10.7683/xxyxyxb.2022.08.004
文献标志码:
A
摘要:
目的　探讨术中使用右美托咪定对行腹腔镜全子宫切除术患者肺功能的影响。方法　选择2020年1月至2021年5月徐州医科大学附属连云港医院收治的60例择期行腹腔镜全子宫切除术的患者为研究对象，采用随机数字法将患者分为右美托咪定组和对照组，每组30例。右美托咪定组患者于麻醉诱导前15 min静脉泵注负荷剂量(0.6 μg·kg-1）的右美托咪定，对照组患者静脉泵注等体积的生理盐水；负荷剂量泵注完毕后2组患者采用相同的方式进行麻醉诱导和维持。麻醉维持开始时右美托咪定组患者以0.5 μg·kg-1·h-1的速度持续静脉泵注右美托咪定至手术结束前30 min，对照组患者以相同的方式静脉泵注等体积的生理盐水。分别于气管插管后2 min（T1）、建立气腹后2 min（T2）、改为头低脚高位后2 min（T3）、改为头低脚高位后30 min（T4）、改为头低脚高位后60 min（T5）、手术结束时 (T6)记录患者的气道峰压(Ppeak)、气道平台压（Pplat）、气道峰压与平台压差（Praw）和静态肺顺应性（Cst）。分别于术前和术后采用酶联免疫吸附试验检测2组患者血清中白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平。记录并比较2组患者术后并发症。结果　右美托咪定组患者各时间点的Ppeak、Pplat和Praw显著低于对照组，Cst均显著高于对照组（P<0.05）。2组患者T2、T3、T4、T5时的Ppeak和Pplat均高于T1和T6时,T2、T3、T4、T5时的Cst均低于T1和T6时（P<0.05)；其余各时间点的Ppeak、Pplat和Cst比较差异均无统计学意义（P>0.05)。2组患者组内各时间点间Praw比较差异均无统计学意义（P>0.05)。2组患者术前血清IL-6和TNF-α水平比较差异无统计学意义（P>0.05）；2组患者术后血清IL-6和TNF-α水平均显著高于术前（P<0.05）；术后右美托咪定组患者血清IL-6和TNF-α水平显著低于对照组（χ2=0.417、0.480、0.417、0.577、0.884、1.017、1.071，P<0.05）。2组患者术后恶心呕吐、发热、切口感染、咳嗽、肺不张、支气管痉挛和低氧血症发生率比较差异无统计学意义（P>0.05）。结论　腹腔镜全子宫切除术中使用右美托咪定可降低患者气道压，改善肺顺应性，降低血清炎症因子水平，且未增加术后肺部并发症发生率。
Abstract:
Objective　To investigate the effect of dexmedetomidine on pulmonary function of patients undergoing laparoscopic hysterectomy.Methods　A total of 60 patients underwent elective laparoscopic hysterectomy in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2020 to May 2021 were selected as the research objects and they were randomly divided into the dexmedetomidine group and control group,with 30 cases in each group.The patients in the dexmedetomidine group were given loading dose of dexmedetomidine(0.6 μg·kg-1) by intravenous pump at 15 min utes before anesthesia induction,the patients in the control group were given the same volume of normal saline by intravenous pump.After giving the loading dose of dexmedetomidine,the anesthesia induction and anesthesia maintenance were carried out in the same way of the patients in the two groups.At the beginning of anesthesia maintenance,the patients in the dexmedetomidine group were given 0.5 μg·kg-1·h-1 dexmedetomidine by intravenous pump until 30 minutes before the end of the operation,and the patients in the control group were given the same volume of normal saline in the same way.The peak airway pressure (Ppeak),plateau pressure (Pplat),difference between peak airway pressure and plateau pressure (Praw) and the static lung compliance (Cst) at 2 min utes after tracheal intubation (T1),2 min utes after pneumoperitoneum establishment (T2),2 min utes after changing to the trendelenburg position (T3),30 min utes after changing to the trendelenburg position (T4),60 min after changing to the trendelenburg position (T5) and the end of operation (T6) of patients in the two groups was recorded.The levels of serum interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) of patients in the two groups were measured by enzyme-linked immunosorbent assay before and after operation.The postoperative complications of patients in the two groups were recorded and compared.Results　The Ppeak,Pplat and Praw of patients in the dexmedetomidine group were significantly lower than those in the control group,the Cst was significantly higher than that in the control group at each time piont (P<0.05).The Ppeak and Pplat of patients at the T2,T3,T4 and T5 were significantly higher than those at T1 and T6 time piont,and the Cst was significantly lower than that at T1 and T6 in the two groups (P<0.05);there was no significant difference in Ppeak,Pplat and Cst among the other time pionts in the two groups (P>0.05).There was no significant difference in Praw among each time point in the two groups(P>0.05).There was no significant difference in the serum IL-6 and TNF-α levels of patients between the two groups before operation (P>0.05).The serum IL-6 and TNF-α levels of patients after operation were significantly higher than those before operation in the two groups (P<0.05).The serum IL-6 and TNF-α levels of patients in the dexmedetomidine group were significantly lower than those in the control group after operation(P<0.05).There was no significant difference in the incidence of nausea and vomiting,fever,incision infection,cough,atelectasis,bronchospasm and hypoxemia of patients between the two groups after operation (χ2=0.417,0.480,0.417,0.577,0.884,1.017,1.071;P>0.05).Conclusion　　The use of dexmedetomidine in laparoscopic hysterectomy can reduce the airway pressure,improve the pulmonary compliance and reduce the serum levels of inflammatory factors of patients and dose not increase the incidence of postoperative pulmonary complications.

参考文献/References:

［1］　张小军，李云，蒋维维，等.食道压导向的呼气末正压通气对老年患者腹腔镜手术后肺功能的影响［J］.中华麻醉学杂志，2018，38（11）：1362-1365.
ZHANG X J,LI Y,JIANG W W,et al.Effect of positive end-expiratory pressure ventilation guided by esophageal pressure on pulmonary function after laparoscopic surgery in elderly patients［J］.Chin J Anesthesiol,2018,38(11):1362-1365.
［2］　曲度，王毓敖，张弦，等.腹内高压综合征、多脏器危象综合征与机体损伤反应综合征——应用生命多系统时空论对腹腔隙综合征的重新评价［J］.中华普通外科杂志，2002，17（6）：383-384.
QU D,WANG Y A,ZHANG X,et al.Intra-abdominal hypertension syndrome,multi-organ crisis syndrome and body injury response syndrome:a reevaluation of celiac space syndrome using the life multi-system space-time theory［J］.Chin J Gen Surg,2002,17(6):383-384.
［3］　张永强,陈胜阳,田建民,等.右美托咪啶对体外循环下瓣膜置换术后患者心肌和肺功能的影响［J］.新乡医学院学报,2017,34(8):712-716.
ZAHNG Y Q,CHEN S Y,TIAN J M,et al.Effects of dexmedetomidine on myocardial and pulmonary function after valve replacement under cardiopulmonary bypass［J］.J Xinxiang Med Univ,2017,34(8):712-716.
［4］　CHEN W,WANG Y,PAN Z G,et al.Protective effects of dexmedetomidine on the ischemic myocardium in patients undergoing rheumatic heart valve replacement surgery［J］.Exp Ther Med,2021,21(5):427.
［5］　WU M M,LIANG Y X,DAI Z,et al.Perioperative dexmedetomidine reduces delirium after cardiac surgery:a meta-analysis of randomized controlled trials［J］.J Clin Anesth,2018,50:33-42.
［6］　KIM S,PARK S J,NAM S B,et al.Pulmonary effects of dexmedetomidine infusion in thoracic aortic surgery under hypothermic circulatory arrest:a randomized placebo-controlled trial［J］.Sci Rep,2021,11(1):10975.
［7］　李帆，黄一丹，胡振飞，等.肺保护通气与右美托咪定联合应用对胸腔镜下心脏手术患者的肺保护效果［J］.中国体外循环杂志,2021,19(2):99-105.
LI F,HUANG Y D,HU Z F,et al.Effect of lung-protective ventilation combined with dexmedetomidine on lung protection in patients undergoing thoracoscopic heart surgery［J］.Chin J ECC,2021,19(2):99-105.
［8］　GROEBEN H,MITZNER W,BROWN R H.Effects of the alpha2-adrenoceptor agonist dexmedetomidine on bronchoconstriction in dogs［J］.Anesthesiology,2004,100(2):359-363.
［9］　XU B,GAO H,LI D,et al.Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation:a randomized clinical controlled trial［J］.Peer J,2020,8:e9247.
［10］　WU Y,BAI S R,WEI S J,et al.Correlations of IL-6 and CRP gene polymorphisms with pulmonary heart disease［J］.Eur Rev Med Pharmacol Sci,2019,23(18):8109-8114.
［11］　GHOBADI H,MOKHTARI S,ASLANI M R.Serum levels of visfatin,sirtuin-1,and interleukin-6 in stable and acute exacerbation of chronic obstructive pulmonary disease［J］.J Res Med Sci,2021,26:17.
［12］　GHOBADI H,ASLANI M R,HOSSEINIAN A,et al.The correlation of serum brain natriuretic peptide and interleukin-6 with quality of life using the chronic obstructive pulmonary disease assessment test［J］.Med Princ Pract,2017,26(6):509-515.
［13］　OGNJANOVIC S,BRYANT-GREENWOOD G D.Pre-B-cell colony-enhancing factor,a novel cytokine of human fetal membranes［J］.Am J Obstet Gynecol,2002,187(4):1051-1058.
［14］　IQBAL J,ZAIDI M.TNF regulates cellular NAD+ metabolism in primary macrophages［J］.Biochem Biophys Res Commun,2006,342(4):1312-1318.
［15］　CHWALBA A,MACHURA E,ZIORA K,et al.The role of adipokines in the pathogenesis and course of selected respiratory diseases［J］.Endokrynol Pol,2019,70(6):504-510.
［16］　LEE Y C,LIN C Y,CHEN Y H,et al.Essential role of visfatin in lipopolysaccharide and colon ascendens stent peritonitis-induced acute lung injury［J］.Int J Mol Sci,2019,20(7):1678.
［17］　LIU Y,ZHU X,ZHOU D,et al.Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective,double-blind,randomized,placebo-controlled trial［J］.BMC Anesthesiol,2020,20(1):127.
［18］　SOUSA G C,FERNANDES M V,CRUZ F F,et al.Comparative effects of dexmedetomidine and propofol on brain and lung damage in experimental acute ischemic stroke［J］.Sci Rep,2021,11(1):23133.

相似文献/References:

[1]姚瑞萍 ． 胡秀平.腹部横切口全子宫切除术的对照观察[J].新乡医学院学报,2002,19(01):046.
[2]李丽,周晓梅,李雁,等.经阴道和腹腔镜辅助阴式全子宫切除术的对照研究[J].新乡医学院学报,2009,26(01):054.
[3]杨吉武,唐靖,朱新运,等.右美托咪定对高血压病患者腰硬联合麻醉的镇静效应及血流动力学的影响[J].新乡医学院学报,2012,29(05):359.
[4]贾英萍,李郑琛,邱永升. 右美托咪定滴鼻复合七氟醚吸入麻醉在小儿舌系带成形术中的应用[J].新乡医学院学报,2015,32(08):732.
[5]李克寒１,马　丽２,杨惠敏１,等. 右美托咪定对心脏瓣膜置换术患者的脑保护作用[J].新乡医学院学报,2015,32(08):762.
[6]吕绪磊,郝建华.剖宫产术中应用右美托咪定对子宫收缩剂不良反应的作用[J].新乡医学院学报,2015,32(11):1022.
[7]王　旭,张加强.右美托咪定联合七氟烷在小儿先天性心脏病微创封堵手术中的应用效果[J].新乡医学院学报,2021,38(5):445.[doi:10.7683/xxyxyxb.2021.05.010]
　WANG Xu,ZHANG Jiaqiang.Application effect of dexmedetomidine combined with sevoflurane for children with congenital heart disease undergoing minimally invasive closure operation[J].Journal of Xinxiang Medical University,2021,38(8):445.[doi:10.7683/xxyxyxb.2021.05.010]
[8]周　军,张原源,丛旭晖,等.右美托咪定对全身麻醉扁桃体切除术患儿苏醒期躁动的影响[J].新乡医学院学报,2019,36(4):353.[doi:10.7683/xxyxyxb.2019.04.013]
　ZHOU Jun,ZHANG Yuan-yuan,CONG Xu-hui,et al.Effect of dexmedetomidine on agitation during general anesthesia recovery period in children underwent tonsillectomy[J].Journal of Xinxiang Medical University,2019,36(8):353.[doi:10.7683/xxyxyxb.2019.04.013]
[9]杨　燕,张运琼,黄　沾,等.右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应、氧化应激及免疫功能的影响[J].新乡医学院学报,2020,37(3):277.[doi:10.7683/xxyxyxb.2020.03.019]
　YANG Yan,ZHANG Yunqiong,HUANG Zhan,et al.Effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery[J].Journal of Xinxiang Medical University,2020,37(8):277.[doi:10.7683/xxyxyxb.2020.03.019]
[10]张红伟,王卫卫,李晓芳,等.右美托咪定对咽喉部手术鼾症儿童术后躁动及血流动力学的影响[J].新乡医学院学报,2021,38(8):730.[doi:10.7683/xxyxyxb.2021.08.006]
　ZHANG Hongwei,WAGN Weiwei,LI Xiaofang,et al.Effect of dexmedetomidine on postoperative agitation and hemodynamics of patients with snoring after throat surgery[J].Journal of Xinxiang Medical University,2021,38(8):730.[doi:10.7683/xxyxyxb.2021.08.006]

更新日期/Last Update: 2022-08-05