目的 探讨右美托咪定对老年中度慢性阻塞性肺疾病(CORD)患者择期行腹腔镜结直肠癌手术时氧合和无效腔通气的影响.方法 择期行腹腔镜结直肠癌手术COPD患者60例,按照随机数字表法分为两组(n=30):右美托咪定组(D组)和对照组(C组).D组诱导前静注右美托咪定0.5.μg,/kg(＞ 10min),随后0.3μg/(kg·h)泵注至术毕;C组给予相同容量的生理盐水.测定入室时(T0)、气管插管成功后(T1)、人工气腹体位后30min(T2)和60min(T3)动脉血气值.观察气管插管成功后(T1)、人工气腹体位后30min(T2)和60min(T3)气道峰压(Ppeak)、气道平台压(Pplat)和动态肺顺应性(Cdyn),计算无效腔率(VD/VT)和氧合指数(OI).结果 与C组比较,D组T2和T3时点氧合指数均升高(P＜0.05,P＜0.01),Ppeak下降和Cdyn显著升高(P＜0.05,P＜0.01);而两组间pH、PaCO2和Pplat比较差异无统计学意义.麻醉后D组VD/VT呈降低趋势,与C组比较,D组T2和T3时点vD/VT显著下降(P＜0.05).结论 右美托咪定术中输注可显著降低中度COPD患者的气道压力,降低无效腔通气率,改善肺内氧合.%Objective To investigate the effects of dexmedetomidine on oxygenation and dead space ventilation in elderly chronic obstructive pulmonary disease (COPD) patients undergoing laparoscopic colorectal surgery.Methods 60 patients undergoing laparoscopic colorectal surgery were randomly divided into 2 groups (n =30):dexmedetomidine group (D group) and control group (C group).D group received dexmedetomidine 0.5μg/kg (over 10min) before induction,then 0.3μg/(kg · h) continuous infusion until the end of surgery;C group received equal amount of normal saline before inductio.Arterial blood gas analysis were measured when entering the room (T0),after tracheal intubation (T1),30min (T2),60 min (T3) after pneumoperitoneum and position.Peak airway pressure (Ppeak),plateau airway pressure (Pplat) and dynamic lung compliance (Cdyn) were recorded at T1,T2 and T3,at the same time,calculating the rate of dead space(VD/VT) and oxygenation index.Results Compared with C group,at T2,T3 the oxygenation index of D group significantly increased (P ＜ 0.05,P ＜ 0.01),the Peak value decreased and the Cdyn value increased (P ＜ 0.05,P ＜ 0.01);there is no significant difference between the two groups in pH,PaCO2 and Plat.Compared with C group,the VD/VTof D group at T2 and T3 was significantly decreased (P ＜ 0.05).Conclusion Dexmedetomidine infusion can significantly reduce the intraoperative airway pressure in patients with moderate COPD,reduce the dead space ventilation rate,further improve lung oxygenation.
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