单肺通气对七氟醚吸入麻醉肺摄取的影响  

Effect of one-lung ventilation on pulmonary uptake of sevoflurane

作　　者：王伟芝[1] 罗艳华[1] 董桂敏[1] 王绍明[1] 

机构地区：[1]潍坊市人民医院麻醉科,261041

出　　处：《国际麻醉学与复苏杂志》2014年第3期213-216,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的观察吸入麻醉过程中单肺通气（onequngventilation，OLV）与双肺通气（two-lungventilation，TLV）比较七氟醚的肺摄取情况。方法选择食道癌根治术患者15例（OLV组）和胃癌根治术患者15例（TLV组），分别于全麻诱导后插入双腔支气管导管或单腔气管导管控制呼吸，行七氟醚吸入麻醉，记录每组患者各个时点的脑电双频指数（bispectralindex，BIS）、七氟醚吸入气浓度（Fi）和呼出气浓度（Et），并计算Et／Fi，进行组间及组内各时间点的比较。结果组间：OLV组BIS高于TLV组（P〈0．05）；OLV组Et／Fi高于TLV组（P〈0．01）。OLV组：BIS呈逐渐下降趋势，5min达到临床麻醉水平（60），5minN120rain维持在临床麻醉深度（40—60）；Et呈逐渐上升趋势，2min-30min未进入稳态（P〈0．05），30min达到稳态。Et／Fi呈逐渐升高趋势，2min～50min内未进入稳态（P〈0．05），50min达到稳态（连续30min）（P〉0．05），50min～120min变化无统计学意义（P〉0．05）。TLv组：BIS呈逐渐下降趋势，2min达到临床麻醉水平（60），2min～70min维持在临床麻醉深度（40～60），70min～120min低于40；Et呈逐渐上升趋势，2min～20min未进入稳态（P〈0．05），20min达到稳态（连续30min）（P〉0．05）。Et／Fi呈逐渐升高趋势，2min达到稳态，2min。120min变化无统计学意义（P〉0．05）。结论OLV对七氟醚的肺摄取有一定影响。OLV摄取总量少于TLv，2min～50min摄取速率高于TLV。OLV与TLV均可达到满足手术要求的麻醉深度，但TLV组在70min后应适当调整吸入浓度以避免麻醉过深。与TLV比较，OLV麻醉深度较浅，达到稳定麻醉状态的时间较长。Objective To observe the effect of one-lung ventilation （OLV） or two-lung ventilation （TLV） on pulmonary uptake of sevoflurane. Methods Fifteen patients with esophageal tumorectomy and fifteen patients with stomach tumorectomy were selected for OLV and TLV during the operation, respectively. Sevoflurane was used for the general anesthesia. Bispectral index （BIS）, Fi and Et were recorded at each measurement point, and Et/Fi was calculated. Results The BIS value of OLV group was higher than that of TLV group （P〈0.05）, Et/Fi in OLV group was higher than TLV group （P〈0.01）. OLV group： the BIS value gradually decreased and reached into an anesthetic state （BIS： 60） at 5 min, and then enough anesthesia depth （BIS：40-60） was maintained during 5 min-120 rain. Et gradually increased and reached into a steady state at 30 rain. Et/Fi increased and reached into a steady state at 50 min, and the Et/Fi during 50 rain-120 rain had no statistical significance （P〉0.05）. TLV group： the BIS value gradually decreased and reached into an anesthetic state at 2 rain, and then enough anesthesia depth was maintained during 2 min- T0 rain. However, the BIS value was less than 40 after 70 rain. Et gradually increased and reached into a steady state at 20 rain. Et/ Fi gradually increased and reached into a steady state at 2 ruin, and the Et/Fi during 2 min-120 min had no statistical significance （P〉0.05）. Conclusions OLV had an effect on pulmonary uptake of sevoflurane. The total amount of sevoflurane uptake in OLV was less than that in TLV, while the uptake rate of OLV during 2 min-50 rain was faster than that of TLV. Both OLV and TLV could supply a surgery-needed anesthetic depth with sevoflurane inhalant concentration 3%vol. However, inhalant concentration should be adjusted after 70 rain to avoid excessive anesthesia during TLV. Furthermore, the anesthetic depth of OLV was less than that of TLV, and OLV needed a longer time to reach into a steady state compared with TLV.

关 键 词：单肺通气 七氟醚 肺摄取 脑电双频指数 呼出气浓度 

分 类 号：R614[医药卫生—麻醉学]