Effects of Dexmedetomidine on Respiration in Postoperative Patients Undergone General Anesthesia at High Altitude Areas
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摘要:
目的 观察右美托咪定对高海拔地区全麻手术患者术后呼吸的影响。 方法 择期接受气管内全身麻醉下腹腔镜胆囊切除术患者60例，所有患者均在高海拔地区（海拔在2000～3000 m）居住1 a以上。右美托咪定组给予右美托咪定负荷剂量0.6 μg/kg，输注时间10 min。对照组按前组输注速度给予等量生理盐水。术后拔除气管导管后给予吸氧，氧流量3 L/min。于术后1 h进行快速动脉血气检查，并记录术后1 h、3 h、6 h、12 h的血氧饱和度，呼吸频率，记录两组中发生低氧血症患者的人次（血氧饱和度低于85%认为低氧血症）。 结果 氧分压：两组术后各时点氧分压均高于术前（P < 0.05），两组术后各时点氧分压差异无统计学意义（ P > 0.05）。氧饱和度：两组术后各时间点氧饱和度均高于术前（ P < 0.05），右美组术后3 h氧饱和度低于对照组（ P < 0.05）。呼吸次数：右美组术后1 h、3 h、12 h呼吸次数均低于对照组（ P < 0.05）。两组患者术后均未发现氧饱和度低于85%情况。 结论 给予右美托咪定对高海拔地区气管内全身麻醉患者会降低呼吸次数和部分时点的血氧饱和度，但不降低术后1 h氧分压，不会引起术后低氧血症的发生。 Abstract:Objective To observe the effect of dexmedetomidine on respiration in postoperative patients undergone general anesthesia at high altitude areas. Methods 60 patients who received laparoscopic cholecystectomy under tracheal general anesthesia, and all the patients had been living in high altitude area (altitude: 2000 m～3000 m) for at least one year. The patients were randomly assigned into two groups. The dexmedetomidine group received a 10-minute- infusion of dexmedetomidine 0.6 μg/kg, while the control group was given a volume-matched normal saline in same dose. After operation, the tracheal tube was removed and then oxygen 3 L/min was given. A rapid arterial blood gas examination was performed one hour after operation. At the time points of 1 hour, 3 hours, 6 hours and 12 hours after operation, we examined the blood oxygen saturation and the respiratory rate, and recorded the number of patients with hypoxemia in both groups (Hypoxemia was considered to be present when blood oxygen saturation was ≤ 85%). Results The oxygen partial pressure at each postoperative point in both groups was higher than that before surgery (P < 0.05), and there was no statistically significant difference in oxygen partial pressure at each postoperative point in the two groups ( P > 0.05). Oxygen saturation at each time point after operation in both groups was higher than that before operation ( P < 0.05), and oxygen saturation at 3 h after operation in the dexmedetomidine group was lower than that in the control group ( P < 0.05). The respiration rate of the dexmedetomidine group at 1 h, 3 h and 12 h after operation was lower than that of the control group ( P < 0.05). No oxygen saturation below 85% was found in both groups after operation. Conclusion The administration of dexmedetomidine to patients under tracheal general anesthesia at high altitude areas will reduce the number of breaths and blood oxygen saturation at some time points, but it will not reduce the partial pressure of oxygen at 1 min after surgery, and will not cause postoperative hypoxemia. -
Key words:
- Dexmedetomidine /
- High altitude areas /
- General anesthesia /
- Respiration
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表 1 两组基线指标差异比较[（
$\bar x \pm s$ ），n（%）]Table 1. Comparison of baseline data between the two groups [（
$\bar x \pm s$ ），n（%）]指标 右美组（n = 30） 对照组（n = 30） t/χ2 P 年龄（岁） 43.10 ± 10.29 42.17 ± 8.85 0.38 0.708 性别 0.00 1.000 男 8 （26.7） 8 （26.7） 女 22 （73.3） 22 （73.3） ASA分级 0.28 0.598 1 13 （43.3） 11 （36.7） 2 17 （56.7） 19 （63.3） 体重（kg） 66.02 ± 12.71 68.72 ± 12.29 −0.84 0.406 身高（cm） 165.57 ± 8.19 164.73 ± 6.91 0.43 0.672 
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表 2 两组患者各时点氧分压比较（
$\bar x \pm s$ ）Table 2. Comparison of oxygen partial pressure between the two groups at different time points （
$\bar x \pm s$ ）组别 手术前 手术后 右美组（mmHg） 68.57 ± 6.10 128.67 ± 40.31* 对照组（mmHg） 68.27 ± 7.02 124.13 ± 34.29* 与手术前比较，*P < 0.05。
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表 3 两组患者各时点氧饱和度比较（
$\bar x \pm s$ ）Table 3. Comparisons of oxygen partial pressure between the two groups at different time points（
$\bar x \pm s$ ）组别 手术前 术后1 h 术后3 h 术后6 h 术后12 h 右美组（%） 94.23 ± 2.85 98.83 ± 1.02* 97.47 ± 1.81*△ 97.00 ± 2.10* 96.30 ± 1.78* 对照组（%） 93.80 ± 2.88 98.60 ± 1.30* 98.30 ± 1.24* 97.40 ± 1.89* 96.27 ± 2.10* 同组与手术前比较，*P < 0.05；与对照组同一时间点比较， △P < 0.05。
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表 4 两组患者各时点呼吸次数比较（
$\bar x \pm s$ ）Table 4. Comparisons of respiratory rates of patients in the two groups at each time point（
$\bar x \pm s$ ）组别 手术前 术后1 h 术后3 h 术后6 h 术后12 h 右美组（次/min） 17.77 ± 2.03 16.73 ± 1.60*△ 16.80 ± 1.95*△ 17.13 ± 1.46 16.63 ± 1.13*△ 对照组（次/min） 17.87 ± 1.55 18.30 ± 2.05 18.37 ± 1.19 17.87 ± 1.63 17.73 ± 1.44 同组与手术前比较，*P < 0.05；与对照组同一时间点比较， △P < 0.05。
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