两种不同的麻醉方法在单肺通气时对肺内分流影响的比较

Effects of two anesthetic techniques on shunt fraction during one-lung ventilation

目的 比较异丙酚、芬太尼静脉麻醉和异氟醚氧化亚氮吸入麻醉在电视胸腔镜手术(vid-eo-assistedthoracoscopic surgery,VATS)单肺通气(OLV)时对肺内分流(Qs/Ot)的影响。方法 60例行VATS,随机分为异丙酚静脉麻醉组(Ⅰ组,n=30)和异氟醚吸入麻醉组(Ⅱ组,n=30)。全部病例以静注芬太尼2μg/kg、异丙酚2~3 mg/kg、阿曲库铵0.25~0.5 mg/kg诱导插双腔气管导管,然后Ⅰ组用微泵持续注射异丙酚8~10 mg·kg-1·h-1,30~45 min间断静注阿曲库铵0 25~0 5 mg/kg维持,根据患者的麻醉深度作调整。Ⅱ组吸入0 8%~2 0%异氟醚和50%氧化亚氮氧气维持麻醉。OLV 30 min、OLV 60 min 测定血气。结果 OLV期间PaO2Ⅰ组高于Ⅱ组,PaCO2Ⅱ组高于Ⅰ组(P<0.05)。结论 在OLV期间异丙酚静脉麻醉比异氟醚吸入麻醉对肺内分流的影响较小,异氟醚吸入麻醉对机体HPV明显抑制。

Objective To compare the effects of propofol-fentanyl intravenous anesthesia and isoflurane-nitrous oxide inhalation anesthesia on shunt fraction during one-lung ventilation(OLV) for video-assisted thoracoscopic surgery(VATS).Methods 60 patients undergoing VATS were allocated randomly into two groups:the propofol intravenous anesthesia group(group Ⅰ:n=30) and the isofurane inhalation anesthesia group(group Ⅱ:n=30).All cases were injected fentanyl 2μg/kg,propofol 2～3mg/kg and atracurium 0.25～0.5mg/kg to introduce and intubate the double-lumen tracheal tube.For patients in group Ⅰ,we used the infusion pump to inject propofol 8～10mg·kg^(-1)·h^(-1),30～45min continuously,and atracurium 0.25～0.5mg/kg intermittently for maintenance of anesthesia,and adjusted the dose according to the status of the patients.Patients in group Ⅱ inhaled 0.8%～2.0% isoflurane and 50% nitrous oxide-oxygen to remain anesthetic.Blood gas was analyzed 30min after OLV and 60min after OLV.Results PaO_2 of group Ⅰ was higher than that of group Ⅱ during OLV,and PaCO_2 of group Ⅱ was higher than that of group Ⅰ(P<0.05).Conclusion Compared with propofol intravenous anesthesia,the isoflurane inhalation anesthesia has greater influence on shunt fraction during OLV,and it inhibits HPV markedly.