小剂量多巴酚丁胺对老年单肺通气患者术中脑氧饱和度变化率与术后谵妄发生的影响

doi:10.3969/j.issn.2095-9400.2021.04.005

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摘要目的：探究老年单肺通气（OLV）患者应用小剂量多巴酚丁胺对术中脑氧饱和度（rScO2）变化率和术后谵妄（POD）的影响。方法：选取拟于全麻下行OLV的老年患者64例，随机分为观察组（O组）和对照组（C组），每组32例，分别于OLV后泵注盐酸多巴酚丁胺注射液或0.9%氯化钠溶液，速度1.5 μg/（kg·min）至OLV结束。术中除常规监测外，记录麻醉前（T1）、OLV前5 min（T2）、OLV后15 min（T3）、OLV后30 min（T4）、OLV后45 min（T5）、OLV结束后15 min（T6）的rScO2。观察两组患者苏醒期躁动、术后第1、第3、第7天（或出院前）VAS评分和POD发生率。计算两组rScO2变化率，并将患者rScO2变化率与术后CAM评分、Riker镇静-躁动评分、POD发生率行相关性分析，logistic回归分析POD发生的独立危险因素。结果：OLV期间C组患者rScO2随时间呈逐步下降趋势（P＜0.05），O组rScO2至T5时点出现明显下降（P＜0.05），恢复双肺通气后rScO2回升并接近基础水平。O组T5时点HR、rScO2高于C组（P＜0.05）。O组rScO2变化率、苏醒期躁动、CAM评分、POD发生率低于C组（P＜0.05）。两组患者rScO2变化率与Riker镇静-躁动评分和术后第1天CAM评分均呈正相关（P＜0.05）。Logistic回归分析显示rScO2变化率增加、糖尿病史和高龄是POD的独立危险因素（P＜0.05）。结论：小剂量多巴酚丁胺可降低老年患者OLV术中rScO2变化率以及POD的发生率。

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关键词 ：多巴酚丁胺, 单肺通气, 老年, 脑氧饱和度, 术后谵妄

Abstract：Objective: To explore the effect of low-dose dobutamine on intraoperative rScO2 and POD in elderly patients undergoing one-lung ventilation. Methods: Sixty-four elderly patients undergoing OLV under general anesthesia were randomly divided as observation group (group O) and control group (Group C), with 32 cases in each. Dobutamine hydrochloride or normal saline was injected intravenously after OLV, with the speed of 1.5 μg/(kg·min) until the end of OLV. In addition to routine monitoring, the rScO2 was recorded before anesthesia (T1), 5 minutes before OLV (T2), 15 minutes after OLV (T3), 30 minutes after OLV (T4), 45 minutes after OLV (T5), and 15 minutes after OLV (T6). The agitation in recovery period, VAS and POD incidence of the two groups were observed on the 1st, 3rd and 7th day after operation (or before discharge). The change rate of rScO2 in both groups was calculated. The correlation between the change rate of rScO2 and CAM score, Riker sedation-Agitati score, POD were analyzed. The independent risk factors of POD were analyzed by Logistic regression. Results: During the period of OLV, the rScO2 of group C decreased gradually with time (P<0.05), while group O had significant rScO2 decrease at T5 (P<0.05). The HR and rScO2 at T5 in group O were higher than those in group C (P<0.05). The change rate of rScO2, agitation during recovery period, CAM score and incidence of POD in group O were lower than those in group C (P<0.05). The change rate of rScO2 was positively correlated with Riker sedation-Agitati score during recovery period and CAM score on 1st day after operation. Logistic regression analysis showed that the increase of rScO2 change rate, diabetes history and old age were independent risk factors for POD. Conclusion: Low-dose dobutamine can reduce the change rate of cerebral oxygen saturation and postoperative delirium in elderly patients with one-lung ventilation.

Key words： dobutamine one-lung ventilation elderly cerebral oxygen saturation postoperative delirium

收稿日期: 2020-10-16

基金资助:浙江省医药卫生科技计划项目（2021KY310）。

作者简介: 方平，副主任医师，Email：549934608@qq.com。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2021.04.005 或 https://xb.wmu.edu.cn/CN/Y2021/V51/I4/282

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