胸段硬膜外阻滞复合全麻对术中单肺通气患者肺内分流及动脉血氧合的影响

Influence of general-thoracic epidural anaesthesia on intrapulmonary shunt and blood oxygenation during one-lung ventilation

目的研究胸段硬膜外阻滞复合全麻对术中单肺通气(OLV)患者肺内分流及动脉血氧合的影响。方法术中需行OLV的食管癌根治术患者60例(ASAⅠ～Ⅱ级),随机分为单纯使用全麻的对照组以及使用胸段硬膜外阻滞复合全麻的实验组,每组均为30例。分别于麻醉诱导后双肺通气(TLV)时(S1)、单肺通气30min时(S2)、单肺通气60min时(S3)抽取动脉血及混合静脉血行血气分析,并计算肺内分流率(Qs/Qt)与动脉血氧分压(PaO2)。结果所有患者OLV时较TLV时PaO2明显下降,Qs/Qt明显升高(均P<0.05)。组间比较,S1、S2、S3时PaO2、PaCO2、Qs/Qt等差异均无统计学意义(P>0.05)。结论胸段硬膜外阻滞复合全麻不会明显影响OLV患者肺内分流及动脉血氧合。

Objective To investigate the influence of combined general-thoracic epidural anaesthesia on intrapulmonary shunt and blood oxygenation during one-lung ventilation.MethodsSixty patients with cancer of esophagus and ASA Ⅰ-Ⅱ grade were randomly divided into control group(n=30)and experimental group(n=30).The patients in experimental group received combined general-thoracic epidural anaesthesia and the patients in control group received general anaesthesia only.Arterial and venous blood gas analyses were recorded to calculate Qs/Qt and PaO2 when two lung ventilation after induction of anaesthesia(S1),30 min after one lung ventilation(S2)and 60 min after one lung ventilation(S3).Results PaO2 decreased significatly while Qs/Qt rised significatly at S2,S3 than S1 in all patients(all P<0.05).There were no significant differences of Qs/Qt,PaO2 and PaCO2 between two groups(P>0.05).Conclusion Thoracic epidural anaesthesia does not significantly influence intrapulmonary shunt and blood oxygenation during one lung ventilation.