不同浓度布比卡因胸段硬膜外阻滞对单肺通气期间动脉氧合的影响  

Effects of thoracic epidural anesthesia with different concentrations of bupivacaine on arterial oxygenation during one-lung ventilation

作　　者：蒋大明[1] 王丽君[1] 鲁振[1] 顾连兵[1] 

机构地区：[1]江苏省肿瘤医院麻醉科,南京市210009

出　　处：《临床麻醉学杂志》2014年第11期1056-1058,共3页Journal of Clinical Anesthesiology

基　　金：江苏省肿瘤医院资助课题面上项目(ZM201113)

摘　　要：目的观察不同浓度布比卡因胸段硬膜外阻滞对单肺通气（OLV）期间动脉氧合的影响。方法择期行经左胸食管癌根治术患者120例,年龄50~65岁,随机数字表法均分为四组：A、B、C组采用静脉全麻复合硬膜外阻滞,硬膜外分别给予0.5%、0.25%、0.125%布比卡因,D组为单纯静脉全麻,每组30例。A、B、C三组患者诱导前硬膜外注入5ml相应浓度布比卡因,术中以3~5ml/h持续硬膜外泵入。分别于OLV前（T0）、OLV 15min（T1）、OLV 30min（T2）抽取桡动脉血和混合静脉血行血气分析。结果 T1、T2时A组Qs/Qt明显高于其他三组（P〈0.05）,PaO2明显低于其他三组（P〈0.05）。T0~T2时A、B组SBP、DBP均明显低于D组（P〈0.05）。与D组比较,A、B、C组术中阿片类药物和丙泊酚的用量均明显减少（P〈0.05）。结论静脉全麻复合0.125%和0.25%布比卡因胸段硬膜外阻滞在OLV期间不会增加肺内分流和降低动脉氧合。Objective To study the effects of thoracic epidural anesthesia with different concentrations of bupivacaine on arterial oxygenation,shunt fraction（Qs/Qt）during one-lung ventilation,and maintenance doses of propofol and remifentanyl.Methods One hundred twenty patients scheduled for elective thoracic surgery for esophageal cancer were randomly divided into four groups to epidurally receive 0.5%（group A）,0.250%（group B）,0.125%（group C）bupivacaine and none（group D）.Bupivacaine was administered intraoperatively in groups A,B and C（3-5ml of first bolus 5ml/h infusion）.The datas of arterial oxygen tension（PaO2）and Qs/Qt were measured before OLV（T0）,OLV15min（T1）and OLV 30min（T2）.Results Qs/Qt was significantly higher in group A compared with that in other groups at T1 and T2（P〈0.05）.PaO2 was significantly lower in group A compared with that in other groups at T1 and T2（P〈0.05）.Blood pressure was significantly lower in groups A and B compared with that in group D at T0-T2（P〈0.05）.Maintenance doses of propofol and remifentanyl were significantly lower in group A,B and C.Conclusion 0.125% and 0.25% bupivacaine epidural anesthesia neither increase Qs/Qt nor decrease arterial oxygenation during operation,thus superior to0.5% bupivacaine epidural anesthesia.

关 键 词：硬膜外阻滞 单肺通气 动脉血氧合 肺内分流 

分 类 号：R614[医药卫生—麻醉学]