单肺通气期间雷米芬太尼和硬膜外镇痛对血液氧合及肺内分流的影响  

The effects of remifentanil and thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation

作　　者：陈士寿[1] 方能新[1] 李磊[1] 陈燃[1] 曾一平[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥市230022

出　　处：《临床麻醉学杂志》2005年第11期745-747,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较单肺通气(OLV)期间雷米芬太尼和胸段硬膜外镇痛对血液氧合及肺内分流的影响.方法14例择期开胸食管癌根治术患者,ASA Ⅰ～Ⅱ级.于全麻双肺通气(TLV)、雷米芬太尼输注OLV 30 min和停雷米芬太尼胸段硬膜外镇痛OLV 30 min,分别进行动、静脉血气分析,并计算肺内分流率(Qs/Qt).结果与TLV时比较,OLV时动脉血氧分压(PaO2)明显下降,Qs/Qt明显升高(P＜0.01),混合静脉血氧分压(PvO2)、动脉血氧饱和度(SaO2)、动脉血氧含量(CaO2)均明显下降(P＜0.05).但OLV时输注雷米芬太尼与硬膜外镇痛相比,PaO2、Qs/Qt、PvO2、SaO2、CaO2均无显著性差异.结论OLV期间输注雷米芬太尼和硬膜外镇痛对血液氧合和肺内分流无明显影响.Objective To compare the effects of remifentanil and thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation. Methods Fourteen patients undergoing thoracic esophagectomy under general anesthesia during two-lung ventilation before open chest, one-lung ventilation 30 min with remifentanil infusion after open chest ,and one-lung ventilation 30 min with thoracic epidural anesthesia after remifentanil infusion stoped. Arterial and central venous blood gas calculation were performed in analysis and calculate pulmonary shunt fraction （Qs/Qt）. Results PaO2 was significantly decreased, Qs/Qt was significantly higher （P〈0.01）, PrO2, SaO2 and CaO2 were significantly decreased （P〈0.05） during one-lung ventilation compared with those during two-lung ventilation. But there was no significantly difference in those between OLV plus remifentanil＂ infusion and OLV plus thoracic epidural analgesia. Conclusion There was no significantly effect of OLV plus remifentanil infusion or thoracic epidural analgesia on oxygenation and pulmonary shunt fraction.

关 键 词：单肺通气 雷米芬太尼 硬膜外镇痛 氧合 肺内分流 

分 类 号：R614.2[医药卫生—麻醉学]