两种麻醉方法下食道癌根治术患者单肺通气期间肺内分流的比较  

The difference In intrapuimonary shunt during one-lung ventilation under general anesthesia with isoflurane or propofol-remifentanil

作　　者：孙震[1] 尤圣武[2] 吕晶[1] 陈卫民[1] 

机构地区：[1]中国医科大学第二医院麻醉科,沈阳市110004 [2]上海第二医科大学附属瑞金医院麻醉科

出　　处：《中华麻醉学杂志》2006年第2期110-113,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较食管癌根治术患者异丙酚-瑞芬太尼靶控静脉麻醉与异氟醚麻醉下单肺通气(OLV)期间肺内分流的变化。方法择期行中、下段食管癌左侧开胸切除术患者24例,年龄42- 69岁,ASA Ⅰ或Ⅱ级。随机均分为2组:异丙酚-瑞芬太尼组(PR组)和异氟醚组(ISO组)。PR组靶控输注异丙酚和瑞芬太尼,血浆靶浓度分别为3．2μg/ml和4．5μg/ml;ISO组吸入异氟醚(呼气末浓度为 1．5％-2．5％),间断静脉注射芬太尼2μg/kg。持续监测ECG、平均动脉压(MAP)、SpO2、听觉诱发电位指数(AAI)、心脏指数(CI)、气道压(Paw)。麻醉诱导后,插入右双腔支气管导管,分别于平卧位漂浮导管置入后10min(T0)、右侧卧位双肺通气10min(T1)、单肺通气15、30、60、90min(T2-T5)进行动脉血及混合静脉血血气分析,计算肺内分流率(Qs/Qt)。结果两组术中AAI均低于30,PaCO2、pH在正常范围内,组间各时点AAI、PaCO2、pH和Paw比较差异无统计学意义。与T0相比,两组T2-5时Paw升高, T1-5时Qs/Qt增加,于T2达到高峰;PaO2降低,于T2降至最低(P<0．05),而CI差异无统计学意义(P >0．05)。与ISO组比较,T2-5时PR组Qs/Qt降低(P<0．05),PaO2差异无统计学意义。结论与异氟醚麻醉比较,异丙酚-瑞芬太尼麻醉在OLV期间可减少食管癌根治术患者肺内分流,但对PaO2的影响不明显。Objective To determine if propofol-remifentanil and isoflurane have any different effects on intrapulmonary shunt during one-lung ventilation （OLV）. Methods Twenty-four ASA Ⅰ or Ⅱ patients （18 male, 6 female） aged 42-69 yr undergoing radical esophagus cancer resection via left thoracotomy were randomly divided into 2 equal groups （ n = 8 each） ： propofol group （Pro） and isoflurane group （Iso）. The preoperative lung function was normal in both groups. The patients were premedicated with intramuscular diazepam 10 mg and atropine 0.5 mg. Radial artery was eanrmlated and S-G catheter was placed via fight internal jugular vein in pulmonary artery. Anesthesia was induced with propofol 1.5-2.0mg·kg^-1, fentanyl 4μg·kg^-1 and succinylcholine 1.5 mg·kg^-1 and maintained with TCI of propofol and remifentanil （target plasma concentration was set at 3.2μg. ml^-1 and 4.5ng·ml^-1 ） or isoflurane inhalation （ end-tidal isoflurane concentration = 1.5 % -2.5 % ） and intermittent i.v. boluses of fentanyl. The patients were mechanically ventilated after endobronchial intubation with double-lumen tube （ VT = 8-10 ml, RR=10-12 bpm, I：E = 1：2）. During OLV VT was reduced to 6-8 ml and RR increased to 14-16 bpm. PaCO2 was maintained at 35-45 mm Hg. ECG, HR, MAP, SpO2, auditory-evoked potential index （AAI）, cardiac index （CI）, airway pressure and end-tidal isoflurane concentration were continuously monitored during operation. Blood samples were taken from radial artery and pulmonary artery at 10 rain after S-G catheter placement （To, baseline） at 10min bilateral ventilation （in right lateral position） （T1） at 15, 30, 60, 90 min of OLV （T2-5） for measurement of blood gases and calculation of Qa/Qt. Results The two groups were comparable with respect to age, M/F ratio, body weight and preoperative lung function. AAI was below 30 during operation and PaCO2 and pH were within normal range in both groups. Qa/Q1 was significantly increased while PaO2 was significantly decr

关 键 词：二异丙酚 哌淀类 异氟醚 肺通气 通气与血液灌注比值 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]