七氟醚吸入麻醉对单肺通气患者的药动学影响  

Pharmacokinetic influeuce of inhalation anesthetic of sevoflurane on the patients subjected to one-lung ventilation

作　　者：刘海强[1] 

机构地区：[1]解放军89医院麻醉科,山东潍坊261021

出　　处：《实用医药杂志》2016年第1期33-35,共3页Practical Journal of Medicine & Pharmacy

摘　　要：目的 观察七氟醚吸入麻醉中单肺通气(OLV)对其药物代谢动力学的影响.方法 选择食管癌根治术患者15例(OLV组)和胃癌根治患者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(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,5 min达到临床麻醉水平(60),5~120 min维持在临床麻醉深度(40~60);Et呈逐渐上升趋势,30 min达到稳态.Et/Fi呈逐渐升高趋势,50 min达到稳态,50~120 min变化无统计学意义(P>0.05).TLV组:BIS呈逐渐下降趋势,2 min达到临床麻醉水平,2~70 min维持在临床麻醉深度,70~120 min低于40;Et呈逐渐上升趋势,20 min达到稳态.Et/Fi呈逐渐升高趋势,2 min达到稳态,2~120 min变化无统计学意义(P>0.05).结论 七氟醚吸入麻醉中OLV对其摄取有一定影响,摄取总量少于TLV,2~50 min摄取速率高于TLV.在七氟醚吸入浓度为3%vol,氧流量为2 L/min的条件下,OLV与TLV均可达到满足手术要求的麻醉深度,但TLV组在70 min后应调整吸入浓度以避免麻醉过深.相同时点OLV麻醉深度较浅,达到稳定麻醉状态的时间较长(30 min/20 min).Objective To observe the effect of one-lung ventilation of sevoflurane on patient's pharmacokinetic aspects.Methods The 15 patients undergoing esophagus tumorectomy(one-lung ventilation) and 15 patients undergoing stomach tumorectomy(two-lung ventilation) were collected in this study.Double-lumen endobronchial tube or mon-lumen tracheal tube was inserted after general anesthesia to control ventilation.Bispectral Index(BIS),Fi and Et were recorded at every marked time,and Et /Fi was calculated and a comparison of two groups and at marked times was taken.Results BIS of OLV group was higher than TLV group(P<0.05),Et /Fi of OLV group was higher than TLV group(P <0.01).OLV group:BIS generally decreased and got into anesthetic state(60) at 5 minute and could supply enough anesthesia depth during 5-120 min.Et generally increased and got into steady state at 30 minute.Et /Fi generally increased and got into steady state at 50 minute and the difference during 50-120 min had no statistical significance(P>0.05).TLV group:BIS generally decreased and got into anesthetic state at 2 minute and could supply enough anesthesia depth during 2-70 min,BIS was lower than 40 after 70 min.Et generally increased and got into steady state at 20 minute.Et /Fi generally increased and got into steady state at 2 minute and the difference during 2-120 min had no statistical significance(P>0.05).Conclusions One-lung ventilation has effect on pulmonary uptake of sevoflurane.The total amount of OLV is less than it of two-lung ventilation,as uptake-speed during 2-50 min being faster than TLV.With sevoflurane inhalant concentration 3% vol,OLV and TLV could supply surgery-needed anesthetic depth,and for TLV group it should adjust inhalant concentration to avoid excessive anesthesia.Anesthetic depth of OLV is less than it of TLV,and the time getting into steady state is longer than it of TLV(30 min /20 min).

关 键 词：单肺通气 七氟醚 肺摄取 脑电双频指数 

分 类 号：R614[医药卫生—麻醉学]