气道高反应性患者在双腔支气管插管单肺通气期间氨茶碱泵注的临床观察  

Effects of aminophylline infusion on airway pressure during double-lumen endotracheal intubation and one lung ventilation in lung cancer patients with airway hyperreactivity

作　　者：邢珍[1] 王丽[1] 袁明霞[1] 李福龙[1] 赵永泉[1] 

机构地区：[1]河北北方学院附属第一医院麻醉科,河北省张家口市075000

出　　处：《河北医药》2010年第19期2658-2660,共3页Hebei Medical Journal

摘　　要：目的观察气道高反应性患者在双腔支气管插管单肺通气(OLV)期间氨茶碱泵注的临床效果。方法选择行肺癌手术患者76例,男66例,女10例;年龄45～75岁;体重46～74kg;ASAⅠ～Ⅱ级。麻醉诱导后双腔支气管插管,微量泵持续泵注丙泊酚4mg·kg-1.h-1,间断静脉注射维库溴铵、芬太尼维持麻醉。侧卧位后记录右肺通气气道压,分别于麻醉前(入室未吸氧),双肺通气15min,OLV20、60min桡动脉、中心静脉抽血测血气分析。OLV期间出现高气道压,血氧饱和度(SpO2)持续下降病例给予氨茶碱50mg入壶,静脉泵注氨茶碱0.2g+0.9%氯化钠溶液50ml,50ml/h。结果 76例患者中有17例(占22.4%)出现高气道压和SpO2降低。17患者OLV期间常规静脉泵注氨茶碱。17例患者与双肺通气(TLV)时比较,OLV时动脉血氧分压(PaO2)均明显下降,气道峰压(Ppeak)明显升高,二氧化碳分压(PaCO2)上升(P<0.05)。应用氨茶碱OLV60minPpeak明显下降,PaO2上升,PaCO2下降(P<0.05)。结论肺癌合并感染患者在OLV期间出现高气道压和低氧血症,警惕出现支气管痉挛。静脉泵注氨茶碱是安全有效的治疗方法。Objective To investigate the effect of aminophylline infusion on airway pressure during double-lumen endotracheal intubation and one-lung ventilation in patient with airway hyperreactivity.Metheds The seventy-six ASA Ⅰ～Ⅱ patients（66 males and 10 females）aged 45～75y,weighing 46～74kg,who underwent elective lung cancer resection,were enrolled in the study.All the patients were complicated with pulmonary infection.The left-sided double-lumen tube was inserted after induction of anesthesia and correct placement was confirmed by fiberoptic bronchoscopy,the patients were mechanically ventilated.The ventilation conditions were FiO2=100%,VT=8 ml/kg,I∶E=1∶2,f=15bpm during OLV.The anesthesia was maintained with continuous infusion of propofol supplemented with intermittent i.v.boluses of fentanyl and vecuronium.The MAP,HR,ECG,CVP,airway pressure were continuously monitered during anesthesia.Arterial blood gases were analyzed before induction of anesthesia,15min after two-lung ventilation,20min and 60min after OLV.The patients with airway hyperreactivity and lower SpO2 were infused with aminophylline 0.2g＋physiological salt solution 50ml,50ml/h.Results 17（22.4%）of 76 patients appeared high airway pressure and lower SpO2 during OLV.As compared with that during TLV,PaO2 was significantly decreased,however,Ppeak was significantly increased during OLV,and PaCO2 were significantly increased（P〈0.05）.60min after they were infused with aminophylline,Ppeak was significantly decreased,however,PaO2 was significantly increased,and PaCO2 was significantly decreased（P〈0.05）.Conclusion The patients with lung cancer complicated by pulmonary infection appear high airway pressure and hypoxemia during OLV,which may suggest that the patients might occur bronchospasm.The intravenous infusion with aminophylline is an effective and safe way.

关 键 词：肺通气 肺肿瘤 气道高反应 血气分析 呼吸力学 

分 类 号：R285[医药卫生—中药学]