术侧胸椎旁阻滞对单肺通气期间肺内分流及氧合的影响  

Effect of thoracic paravertebral nerve block technique on oxygenation and intrapulmonary shunt during one-lung ventilation in patients undergoing thoracic surgery

作　　者：王莉[1] 宁杰[1] 李艳华[1] 张培俊[1] 

机构地区：[1]云南省第一人民医院麻醉科,昆明市650032

出　　处：《临床麻醉学杂志》2013年第6期564-566,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨术侧切口部位的胸椎旁阻滞对单肺通气(OLV)期间的肺内分流及氧合的影响。方法择期行开胸食管癌根治术患者40例,ASAⅠ～Ⅲ级,年龄40～78岁,随机均分为静脉全麻+胸椎旁阻滞组(A组)和静脉全麻组(B组)。全麻诱导后插入双腔气管导管,麻醉维持采用丙泊酚2～3μg/ml,瑞芬太尼0.1～0.2μg·kg-1·min-1。在侧卧位OLV前[双肺通气(TLV)时,T0]、OLV15min(T1)、30min(T2)、60min(T3)时抽取患者动、静脉血,行血气分析。记录MAP、心脏指数(CI)、HR、PaO2,计算肺内分流率(Qs/Qt)。结果两组患者不同时点MAP、HR、CI等差异无统计学意义。与T0时比较,T1～T3时两组患者的PaO2均明显降低(P<0.01),Qs/Qt明显升高(P<0.05),但两组间差异无统计学意义。结论开胸手术时术侧切口的胸椎旁神经阻滞OLV期间不增加肺内分流。Objective To investigate the effect of thoracic paravertebral nerve block（TPVB）on oxygenation and intrapulmonary shunt during one-lung ventilation （OLV） in patients undergoing thoracic surgery. Methods Forty ASA Ⅰ-Ⅲ patients aging 40-78 years old, undergoing thoracic esophageal carcinoma surgery were divided into two groups： thoracic paravertebral nerve block combined with general anesthesia group （group A） and general anesthesia group（group B）. Double lumen tube was inserted after general anesthesial induction. Propofol 2-3 μg/ml, remifentanil 0. 1-0. 2 μg·kg-1·min-1 were given for maintenance of anesthesia. Arterial and pulmonary blood gases were analyzed before OLV（T0）, during OLV 15 min （T1）, 30 min（T2）, 60 rain（T3） in all patients, respectively. Venous admixture percentage （Qs/Qt）, arterial and mixture venous oxygen content were measured. MAP, CI, HR and PaO2 at each time point were recorded. Results There was no difference at each time point in MAP, HR and CI between the two groups. Compared with To, PaO2 decreased and Qs/Qt increased significantly at T1-T3 in both groups（P〈0.05 or P〈0.01）. There was no significant difference between two groups in Qs/Qt and PaO2. Conclusion TPVB would not affect intrapulmonary shunt during the period of OLV in thoracic surgery.

关 键 词：胸椎旁神经阻滞 单肺通气 开胸手术 

分 类 号：R614[医药卫生—麻醉学]