七氟烷和异丙酚对单肺通气肺内分流和氧合的影响  

Impact of sevoflurane and propofol anesthesia on intrapulmonary shunt and arterial oxygenation during one-lung ventilation

作　　者：倪剑武 杨涛[2] 张学政[2] 方向宇 蒋柳明[2] 吴辉[2] 

机构地区：[1]温州市第八人民医院麻醉科,浙江温州325000 [2]温州医学院附属第一医院麻醉科,浙江温州325000

出　　处：《温州医学院学报》2010年第3期273-275,279,共4页Journal of Wenzhou Medical College

摘　　要：目的:比较相似的麻醉深度下(BIS维持于40～60范围),七氟烷和异丙酚对单肺通气(OLV)期间患者肺内分流和氧合的影响。方法:80例作肺叶切除术的患者,随机分为七氟烷组(S组)和异丙酚组(P组)。两组患者均采用全麻复合连续硬膜外麻醉,全麻诱导方法相同,插入双腔管后S组以七氟烷维持,P组以异丙酚维持。在OLV前的双肺通气(TLV)阶段和OLV阶段前40 min内取9个时间点采集动脉血和右心房血进行血气分析,同时记录血流动力学指标以及相关的临床数据。结果:相比TLV期间,OLV下两组患者的平均动脉血氧分压均有明显下降(P<0.05),但组间比较差异无显著性(P>0.05)。OLV下两组肺内分流明显增多(P<0.05),其中S组的肺内分流更明显(P<0.05)。结论:较低浓度七氟烷和异丙酚在OLV期间均使肺内分流增加,但七氟烷增加肺内分流更明显,两者对动脉血氧分压影响相似。Objective：To compare the effects of sevoflurane and propofol on oxygenation and intrapulmonary shunt during in one-lung ventilation（OLV） at the similar anesthesia depth,with their administration to maintain bispectral index（BIS） values between 40 and 60.Methods：Eighty patients scheduled for a lobectomy,receiving an epidural administration of ropivacaine,were randomly assigned to Group S（maintenance with sevoflurane） or Group P（maintenance with propofol）.Took nine time points after placement of a double-lumen tube,arterial and right atrium blood gas samples were taken,hemodynamic parameters and the associated cilinical data were recorded during TLV and the first 40 min of OLV.Results：During the period compared to TLV,the mean PaO2 of the two groups were decreased in OLV（P 0.05）h,owever,no statistical differences were observed between the two groups（P 0.05）.The intrapulmonary shunt of two groups was increased during OLV（P 0.05）,but the intrapulmonary shunt of Group S was more obvious than that of the Group P（P 0.05）.Conclusion：Lower concentration of sevoflurane and propofol increases intrapulmonary shunt during OLV,sevoflurane increased intrapulmonary shunt is more obviously than that of propofol,and they have similar effects on mean PaO2 during OLV.

关 键 词：异丙酚 七氟烷 肺换气 血气分析 

分 类 号：R614.2[医药卫生—麻醉学]