高氧液对单肺通气低氧血症和肺内分流的影响  

Effects of hyperoxia solution on oxygenation and intrapulmonary shunt during one-lung anesthesia

作　　者：娄彦[1] 郑海涛[1] 贾晓辉[1] 蔡明[1] 胡杰[1] 

机构地区：[1]洛阳市中心医院麻醉科,河南洛阳471009

出　　处：《中国现代医学杂志》2005年第13期2031-2034,共4页China Journal of Modern Medicine

摘　　要：目的探讨双腔支气管内麻醉时,输入高氧液对单肺通气时低氧血症和肺内分流(Qs/Qt)的影响。方法选择食管中段癌根治手术20例,随机分为两组,N组(对照组)10例单肺通气时输入平衡液;O组(高氧液组)10例单肺通气时输入高氧平衡液。分别于麻醉前、双肺通气(DLV)30min、单肺通气(OLV)30min抽取动脉血和混合静脉血做血气分析,并计算Qs/Qt等。结果OLV时O组动脉血氧饱和度(SaO2)显著高于N组(P<0.01),O组动脉血氧含量(CaO2)显著高于N组(P<0.05)。OLV时,Qs/Qt较DLV时显著增加(N组P<0.01;O组P<0.05),但两组间比较差异无显著性。结论静脉输注高氧液可以明显升高SaO2和CaO2,高氧液对Qs/Qt的影响不明显。单肺通气时输注高氧液可能对低氧血症有利。[Objective] To study the effects of hyperoxia solution on arterial oxygenation and intrapulmonary shunt during one-lung ventilation (OLV). [Methods] Twenty ASAⅠ, Ⅱ patients with normal ventilative function undergoing thoracic surgery were enrolled in this study. Patients with abnormal cardiac, liver or kidney function were excluded. The patients were premedicated with atropine 0.5 mg and luminal 0.1 I.M. General anesthesia was induced with midazolam 0.1 mg/kg, propofol 1 mg/kg, fentanyl 5 μg/kg and vecuronium 0.1 mg/kg. Double-lumen catheter was inserted and its correct position was confirmed by a combination of unilateral lung ventilation and auscultation in both supine and lateral position. The patients were mechanically ventilated. Tidal volume was set at 10 mL/kg, FiO2=1, I:E=1:1.5, RR=10~12 bpm and PETCO2 was maintained between 38~42 mmHg. The parameters remained unchanged during OLV. The patients were divided into two groups: control group (Group N, n=10) and hyperoxia solution (hyperoxia lactate Ringer′s solution) group (Group O, n=10). In Group O, hyperoxia solution was administered intravenously when OLV at the rate of 0.25 mL (kg·min) and in Group N, lactate Ringer′s solution (LRS) was used in place of hyperoxia solution. ECG, HR, SBP, DBP, SpO2, CVP, PETCO2 and TOF were continuously monitored during operation. Arterial and mixed venous blood gas analysis were recorded and Qs/Qt was calculated in both groups before anesthesia, 30 min after double-lung ventilation (DLV) and 30 min after OLV. [Results] During the period of OLV, PaO2 in Group O was larger than those in Group N (P <0.05), SaO2 in Group O was larger than those in Group N (P <0.01) and CaO2 in Group O was larger than those in Group N (P <0.05). Qs/Qt in both groups was increased significantly (P <0.05 in Group O, P <0.01 in Group N) compared with that during DLV, but there was no significant difference between the two groups. [Conclusions] During OLV, intravenous hyperoxia solution infusion increases arterial oxygenation but does no

关 键 词：高氧液 单肺通气 低氧血症 肺内分流 

分 类 号：R459.6[医药卫生—治疗学]