微流量循环紧闭麻醉用于单肺通气的临床评估  

Clinical evaluation of the safty and feasibility of mico-flow closed-circuit anesthesia performing in one-lung ventilationation

作　　者：周新[1] 程红[2] 

机构地区：[1]山东大学附属省立医院麻醉科,山东济南250021 [2]山东大学附属济南市中心医院麻醉科,山东济南250013

出　　处：《第四军医大学学报》2009年第20期2228-2230,共3页Journal of the Fourth Military Medical University

摘　　要：目的:评价微流量循环紧闭麻醉(MFCCA)用于单肺通气(OLV)胸科手术的可行性.方法:30例ASAII级择期开胸手术的OLV患者,随机分为两组,Ⅰ组:采用氧流量250～350mL/min的异氟醚MFCCA;Ⅱ组:采用氧流量1.5L/min的异氟醚中流量半紧闭吸入麻醉(SCA).手术开始后,于双肺通气(TLV)改OLV前(T1)、OLV15min(T2)、OLV30min(T3)、OLV60min(T4)、OLV改TLV前(T5)5个时间点分别记录血流动力学指标、多气体监测指标,同时于上述时间点分别采集桡动脉血和混合静脉血行血气分析.结果:两组的血流动力学指标、FinCO2和FetCO2,PaO2及动静脉血气分析组间比较无统计学差异,且都在正常范围内.Ⅰ组的FiO2和FeO2在OLV各时间点最低值为T5时的87.4%.Ⅰ组的FinISO和FexISO在各个时间点均较Ⅱ组高(P<0.05).两组组内OLV各时间点的PaO2值均较侧卧位TLV(T1时)明显降低(P<0.05).结论:MFCCA可安全地用于OLV胸科手术患者,并能提供足够麻醉深度;患者FiO2均在80%以上,无供氧不足之虑;使用纯氧吸入异氟醚MFCCA时,OLV在1.5h以内是安全的.AIM： To evaluate the feasibility of micro-flow closed-circuit anesthesia （ MFCCA ） in patients undergoing one-lung ventilation（OLV） during elective thoracic surgery, and to provide the consequent safe parameters. METHODS： Thirty patients, scheduled for thoracic surgery were allocated into the study. The patients were divided into MFCCA group （group Ⅰ, n = 15 and SCA group （group Ⅱ, n = 15 ） When the operation began, hemodynamic （HR, SBP, DBP, MAP） and multi-gas parameters（FiO2 and FeO2, Fet CO2 and FinCO2, FinlSO and FexlSO） were recorded at following intervals： ① TLV before changing OLV （T1 ）, ②15, 30, 60 rain during the course of OLV（ T2, T3, T4 ）, ③ OLV before changing TLV （ T5 ）. The arterial/venous blood samples were taken at the above intervals for blood gas analysis simultaneously. RESULTS： FiO2 and FeO2 during OLV in group I were significantly lower than during TLV in lateral position （ P 〈 0.05 ）. The lsoflurane concentration （ FinISO and FexISO ） in group Ⅰ during TLV and OLV was significantly higher than in group Ⅱ （ P 〈 0.05 ） , the FinISO and FexISO were stable duing the OLV intervals （ T2, T3, T4, T5 ） in group Ⅰ, the group Ⅱ needed more time to reach the stable concentration, and needed large Isoflurane dosage to reach the predetermined concentration of group Ⅰ. The OLV increased PaO2 decreased signifieantly（P 〈 0. 05） in the 2 groups. CONCLUSION： CA performing in patients undergoing OLV during elective thoracic surgery is feasible, and the depth of anesthesia was satisfied. The FiO2 were all above 80%. The safe duration of OLV under MFCCA with Isoflurane was 1.5 h.

关 键 词：麻醉 循环紧闭 微流量 单肺通气 

分 类 号：R614.21[医药卫生—麻醉学]