双肺通气人工气胸期间七氟醚对食管癌根治术患者肺内分流的影响  

Effect of sevoflurane on intrapulmonary shunt during artificial pneumothorax in esophagectomy

作　　者：周琴 李利文[2] 陈名久[2] 罗素梅 周永鹏 徐军美 Qin Zhou;Li-wen Li;Ming-jiu Chen;Su-mei Luo;Yong-peng Zhou;Jun-mei Xu(Hunan Provincial People’s Hospital,Changsha,Hunan 410005,China;The Second Xiangya Hospital of Central South University,Changsha,Hunan 410011,China)

机构地区：[1]湖南省人民医院,湖南长沙410005 [2]中南大学湘雅二医院,湖南长沙410011

出　　处：《中国现代医学杂志》2020年第23期62-65,共4页China Journal of Modern Medicine

摘　　要：目的探讨单腔气管插管双肺通气人工气胸期间七氟醚对联合胸腹腔镜行食管癌根治术患者肺内分流的影响。方法选取2018年5月—2019年2月中南大学湘雅二医院行单腔气管插管人工气胸下腔镜食管癌根治术患者60例,采用随机数字表法将患者分为对照组和七氟醚组,每组30例。记录人工气胸后即刻(T1)、30 min(T2)、60 min(T3)、90 min(T4)的平均动脉压(MAP)、心率(HR)、动脉血氧分压(PaO2)及动脉血二氧化碳分压(PaCO2),同时采集桡动脉血和颈内静脉血各1 ml分别行血气分析并计算肺内分流率(Qs/Qt)。结果两组术中MAP、HR在不同时间点、组间、变化趋势均无差异(P>0.05)。两组肺内分流率比较,在不同时间点、组间、变化趋势均有差异(P<0.05),与T1比较,两组T2、T3、T4的肺内分流率均升高(P<0.05),且在T3最高;两组在各时间点的肺内分流率比较采用独立样本t检验,在T1、T2时肺内分流率比较无差异(P>0.05),T3、T4时七氟醚组高于对照组(P<0.05)。两组PaO2比较,不同时间点有差异(P<0.05),其他时间点较T1均降低,其中在T3最低;两组间无差异(P>0.05);两组的变化趋势无差异(P>0.05)。两组PaCO2比较,不同时间点有差异(P<0.05),其他时间点均较T1升高;两组间无差异(P>0.05);两组的变化趋势无差异(P>0.05)。结论在单腔气管插管双肺通气下行腔镜食管癌根治术患者人工气胸期间全程使用1.0最低肺泡有效浓度(MAC)七氟醚可能增加肺内分流。Objective To investigate the effect of sevoflurane on the intrapulmonary shunt in patients with single-lumen endotracheal tube combined with CO2 artificial pnumothorax in the totally minimally invasive esophagectomy.Methods Totally 60 patients were randomly divided into two groups with 30 subjects in each group:control group(group A)and sevoflurane group(group B).Arterial blood gases,mixed venous blood gases,and shunt fraction(Qs/Qt)were analyzed at 0 minute(T1),30 minutes(T2),60 minutes(T3),90 minutes(T4)after artificial pneumothorax.Results There was no statistical significance between the two groups in terms of HR and MAP at four points(P>0.05),but differences existed in the comparison of shunt fraction(P<0.05).Compared with T1,intrapulmonary shunt of two groups increased at T2,T3,and T4(P<0.05),and it is the highest at T3.Comparing with the group A at the T3 and T4 points,pulmonary shunt fractions was statistically significant(P<0.05),which showed sevoflurane was higher in group B than in group A,but there was no statistical significance at the rest of the time points(P>0.05).Conclusions Compared with intravenous anesthesia,the use of 1.0 MAC sevoflurane in patients with single-lumen endotracheal tube combined with CO2 artificial pnumothorax in the totally minimally invasive esophagectomy may increase intrapulmonary shunt.

关 键 词：食管肿瘤 七氟醚 人工气胸 肺内分流 

分 类 号：R614.2[医药卫生—麻醉学]