不同全麻药物复合胸部硬膜外阻滞对单肺通气肺内分流和氧合的影响  

Comparison of the effects of isoflurane and propofol in conjunction with thoracic epidural block on oxygenation and shunt fraction during one-lung anesthesia

作　　者：孙颖[1] 冯艺[1] 杨拔贤[1] 

机构地区：[1]北京大学人民医院麻醉科,100044

出　　处：《中华麻醉学杂志》2002年第7期403-407,共5页Chinese Journal of Anesthesiology

摘　　要：目的 比较静脉异丙酚和异氟醚吸入全麻复合胸部硬膜外麻醉时,单肺通气期间肺内分流和动脉氧合的变化。方法 24例ASAI-Ⅲ择期需单肺通气开胸手术病人,随机分为静脉异丙酚组（GP组,n=12）和异氟醚吸入组（GI组,n=12）。两组均以0.5％罗哌卡因行胸部硬膜外阻滞。连续监测MAP,MPAP,CO,ECG,HR,SPO2。调整异丙酚输注速度或异氟醚吸入浓度使脑电BIS维持在44～55。分别于清醒仰卧位,侧卧位双肺通气30、单肺通气5、15、30、和60、再次双肺通气30min,测定动脉及混合静脉血血气,计算肺内分流率（Qs/Qt）。结果 两组病人麻醉侧卧双肺通气后肺内分流均明显增加（P<0.01）。单肺通气5min后,肺内分流进一步增加,GP组15min达到高峰[（31.1±4.2）％],GI组30min达到高峰[（33.5±7.8）％」,GI组在30min和60min[（33.1±7.1）％」时肺内分流率显著高于GP组[30min:（28.4±4.6）％;60min:（28.4±3.6）％」。两组单肺通气时PaO2较双肺通气明显下降（P<0.05）,至15～30min时达到最低,但两组间PaO2差异无显著性。除GI组 MAP略低于GP组外,两组间PvO2、MPAP、CVP、CI和 HR无显著差异。结论 在胸部硬膜外阻滞下,静脉异丙酚麻醉比异氟醚吸入全麻对单肺通气期间肺内分流影响较小,但对PaO2影响无明显差异。Objective To compare the effects of isoflurane and propofol on arterial oxygenation and intrapulmonary shunt during one-lung ventilation (OLV) when combined with continuous thoracic epidural block. Methods Twenty-four ASA Ⅰ -Ⅱ patients with normal ventilatory function undergoing elective thoracic surgery were enrolled in this study. Patients with abnormal cardiac, liver or kidney function were excluded. The patients were premedicated with scopolamine 0. 3mg I. M. .Epidural block was performed at T7-8 or T8-9 . An epidural catheter was placed and its position confirmed by epidural 1% lidocaine 5 ml. General anesthesia was induced with propofol l.5mg·kg-1, fentanyl 3μg·kg-1 and vecuronium 0.lmg·kg-1 . Double-lumen catheter was inserted and its correct position was confirmed by a combination of unilateral lung ventilation and auscultation in both supine and lateral position. The patients were mechanically ventilated. Tidal volume was set at 8-10 ml·kg-1, FiO2 = 1, I:E=1:1.5, RR=10-12bpm and PETCO2 was maintained between 35-45 mm Hg. The parameters remained unchanged during one-lung ventilation. The patients were assigned to one of two groups : propofol group and isoflurane group. Anesthesia was maintained with propofol infusion in propofol group and isoflurane inhalation in isoflurane group and BIS was maintained at 45-55. A bolus of 0.5 % ropivacaine 7-9ml was given epidurally followed by 0.5% ropivacaine infusion at a rate of 3-5ml·h-1 in both groups during maintenance of anesthesia. Besides ECG, BP and BIS, continuous cardiac output(CCO Baxter) was monitored during operation. Blood samples were taken from radial artery and pulmonary artery simultaneously before anesthesia when patients were lying supine and breathing spontaneously (T0 ), in lateral position when both lungs were ventilated (T1 ), at 5,15, 30, 60 min of one-lung ventilation(T2-5 ) and when both lungs were ventilated again for 30min(T6) for blood gas analysis. Qs/Qt was calculated.Results (1) The two groups were comparable with respect to

关 键 词：全麻药物 胸部 硬膜外阻滞 单肺通气 肺内分流 氧合 异氟烷 异丙酚 

分 类 号：R614.1[医药卫生—麻醉学]