七氟醚及丙泊酚对单肺通气患者局部脑氧饱和度影响的比较  

Comparison of sevoflurane with propofol on regional cerebral oxygen saturation index of patients undergoing one-lung ventilation

作　　者：刘卓[1] 罗艳[1] 薛庆生[1] 张富军[1] 于布为[1] 李一亮[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,200025

出　　处：《临床麻醉学杂志》2013年第1期5-8,共4页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金青年科学基金项目(30901410)

摘　　要：目的比较七氟醚吸入麻醉和丙泊酚全凭静脉麻醉对胸科手术单肺通气(OLV)患者局部脑氧饱和度(rSO2)及血流动力学的影响。方法选择择期行肺叶/段切除或纵隔肿物切除手术的患者40例,ASAⅠ或Ⅱ级,随机均分为两组:七氟醚组(S组)和丙泊酚组(P组)。S组:8%七氟醚吸入诱导;P组:丙泊酚静脉诱导,血浆靶浓度设为4.5μg/ml,当Narcotrend数值降至80后,静注维库溴铵0.15mg/kg和芬太尼3μg/kg,Narcotrend数值降至55以下且TOF为0时,行双腔气管插管。术中维持:S组吸入浓度为1.5%～4.0%七氟醚,P组丙泊酚血浆靶浓度2.5～5.0μg/ml,维持Narcotrend在26～55,间断静注芬太尼和维库溴铵。记录两组诱导时间及诱导前(T0)、诱导后4min(T1)、插管即刻(T2)、插管后5min(T3)、手术切皮(T4)、OLV 30min(T5)、OLV 60min(T6)、手术结束(T7)时的MAP、HR、SpO2、左、右侧rSO2值。结果与T0时比较,T1～T7时S组、T1和T3～T6时P组患者MAP明显降低(P<0.05);T1～T4和T7时两组患者SpO2明显升高(P<0.05);T2、T3时两组患者左、右侧rSO2明显升高(P<0.05);T1～T7时S组HR差异无统计学意义。与P组比较,T2、T6、T7时S组患者MAP明显降低(P<0.05);T3～T6时左侧和T4、T7时右侧S组患者的rSO2明显升高(P<0.05)。S组诱导时间(6.38±0.81)min明显长于P组(5.56±1.20)min(P<0.05)。结论与丙泊酚全凭静脉麻醉比较,七氟醚吸入麻醉患者的rSO2较高,有助于增加围术期的脑氧灌注,且血流动力学更平稳,但诱导时间长。Objective To compare the effects of sevoflurane and propofol anesthesia on regional cerebral oxygen saturation index and hemodynamics in patients underwent one lung ventilation. Methods Forty ASA Ⅰ or Ⅱ patients underwent elective pulmonary or mediastinal tumor resection surgery were randomly divided into 2 groups （n= 20 each）： group sevoflurane （group S） and group propofol （group P）. Anesthesia was induced with inhalation of 8%sevoflurane in group S or target-controlled infusion of propofol （4.5 μg/ml） in group P, until the Narcotrend decreased to 80,then vercuronium 0.15 mg/kg and fentany 3 μg/kg was administered. When the Narcotrend decreased under 55 and the TOF was 0, double lumen tube was intubated. Anesthesia was maintained with either 1.5%-4. 0% sevoflurane or 2.5-5.0μg/ml propofol in each group to maintain Narcotrend values between 26 and 55. MAP, HR, SpO2, rSO2 were recorded at the following time points： before induction（T0）, 4 min after induction （T1）, immediate after intubation,（T2 ）, 5 min after intubation （Ta）, incision（T4 ）, 30 min（T5 ）, 60 min after one lung ventilation（T6 ）, end of the surgery（T7 ）in both groups. Results Compared with To, MAP at T1-T7 in group S and T1, T3-T6 in group P were significantly decreased （P〈0.05） ,SpO2 at T1-T4 and T7 ,rSO2 at T2 ,T3 in both the two groups were obviously increased （P〈0.05）. Compared with group P, MAP in group S was significantly lower at the time of T2 ,T6 ,T7 （P〈0.05） ,and the duration of induction was longer than group P （P〈0. 05）. Left side regional cerebral oxygen saturation index was significantly higher than those in group P at the following time points：T3-T6 （P〈0.05）, while right side regional cerebral oxygen saturation index was higher than group P at T4, T7 （P〈0. 05）. The induction time of group S （6.38±0.81） rain was significantly longer than group P （5.56±1.20） min （P〈0.05）. Conclusion Compared with propofol intravenous anesthesia

关 键 词：七氟醚 吸入诱导 丙泊酚 静脉诱导 血流动力学 局部脑氧饱和度 

分 类 号：R614[医药卫生—麻醉学]