不同麻醉长时间单肺通气对肺内分流和氧合的影响  

Effects Of Single Anesthesia For Single Lung Ventilation On Pulmonary Shunt And Oxygenation

作　　者：吕治全[1] 彭明清[1] Lv Zhi-quan;PENG Ming-qing(Yongchuan Hospital,Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院麻醉科,重庆市402160

出　　处：《中国全科医学》2017年第B12期134-136,共3页Chinese General Practice

摘　　要：目的观察并探究不同麻醉方法用于长时间单肺通气时,对肺内分流和氧合的影响情况。方法选取来重庆医科大学附属永川医院行单肺通气开胸术的80例患者为研究对象,将其随机分为静脉异丙酚(GP)组、静脉异丙酚复合硬膜外(GPE)组、异氟醚吸入(GI)组及异氟醚吸人复合硬膜外(GIE)组,每组20例。对四组患者不同时间点的肺内分流率及氧合变化情况进行测定与比较。结果单肺通气后,所有患者的肺内分流率不断增加,于T3至T4达到高峰后逐渐降低;动脉血氧分压(PaO_2)则显著下降,于T3至T5时达到最低点后逐渐回升。GI组患者的肺内分流率明显高于其他三组(P<0.05),四组的PaO_2比较差异无统计学意义(P>0.05)。结论在采用不同麻醉方法时,随着时间的延长,患者单肺通气后的肺内分流及PaO_2会得到逐步改善。与静脉异丙酚麻醉相比,异氟醚吸入麻醉不会降低PaO_2,但会增加肺内分流。此外,复合胸段硬膜外罗哌卡因阻滞尽管不会对肺内分流及氧合造成影响,但会影响到循环。Objective To observe and explore impacts of different methods of anesthesia on pulmonary shunt and oxygenation in lung ventilation for a long time.Methods 80 cases admitted in Yongchuan Hospital,Chongqing Medical University were randomly divided into intravenous propofol(GP)group,intravenous propofol combined with epidural(GPE)group,isoflurane ether inhalation(GI)group and isoflurane inhalation combined with epidural(GIE)group,20 cases in each group.Pulmonary shunt fraction and oxygenation changes in patients at four different time points were measured and compared.Results After one-lung ventilation,pulmonary shunt rate for all patients is increasing firstly,then decreased after peaking at T3 to T4.PaO2 decreased significantly at T3 to T5 gradual,with recovery time reaching the lowest point.Pulmonary shunt fraction in GI group were significantly higher than those in other three groups(P<0.05).PaO2 in four groups had no significant difference(P>0.05).Conclusion When using different methods of anesthesia,pulmonary shunt and PaO2 will be gradually improved after one-lung ventilation with time.Compared with intravenous propofol,isoflurane anesthesia does not reduce PaO2.It will increase the pulmonary shunt.In addition,ropivacaine will affect the body circulation.

关 键 词：麻醉 长时间单肺通气 肺内分流 氧合 

分 类 号：R614[医药卫生—麻醉学]