异丙酚靶控输注对单肺通气肺内分流的影响

Effects of Target Controlled Infusion of Propofol on Intrapulmonary Shunt during One-lung Ventilation

目的:研究异丙酚靶控输注(TCI)对单肺通气(OLV)时肺内分流、动脉氧合和肺顺应性(Cdyn)的影响。方法:选择20例ASAI^II级开胸手术患者随机分为两组(每组10例),异丙酚TCI组(P组)设定诱导时靶浓度为4μg/mL,术中维持为3~5μg/mL,对照组用异氟醚0.7~1.3MAC吸入维持麻醉。在麻醉后双肺通气(TLV)10min(t1)、单肺通气(OLV)30min(t2)、OLV60min(t3)、OLV120min(t4)、恢复TLV30min(t5)各时间里抽取动脉血和右心房血行血气分析并计算肺内分流率(Qs/Qt)及肺顺应性(Cdyn)。结果:术中两组生命体征维持平稳,OLV后t2、t3、t4与t1相比两组Qs/Qt有明显升高(P<0.05),而PaO2明显下降(P<0.05),但两组间比较差异无显著性。Cdyn在C组下降明显(P<0.05),两组比较差异显著。结论:异丙酚靶控输注与异氟醚比较并不明显增加肺内分流、降低动脉血氧分压及肺顺应性,且术中血流动力学稳定。

Objective To explore the effect of target controlled infusion （TCI） of propofol on intrapulmunary shunt oxygenation and pulmonary dynamic compliance （Cdyn） during one - lung ventilation （OLV） Methods 20 patients undergoing thoracic operations were randomly divided into two groups. The patients in p-group were given TCI with target concentration 4μg/ml during induction and 3 - 5μg/ml during maintenance, 0. 7 - 1.3 MAC isoflurane during maintenance were inhaled in C - group. The arterial and right atrium blood were taken for blood gas analysis at the following time. TLV 10 min（t1）, OLV 30min（t2）, OLV 60 min（t3）, OLV 120 min（t4）, TLV 30 min（t5）, and the Qs/Qt CAyn was calculated. Results The vital signs were stable in the two groups during surgery. Qs/Qt were in creased at t2, t3 or h compared with that at h, inside the each group, PaO2 were decreased significantly, but between the two groups, the differences were not significant. Cdyn decreased significantly in C - group and there were significant differences between the two groups. Conclusion Propofol with TCI was not associated with a significant increase in intrapulmonary shunt and decrease in PaO2 and Cdyn during OLV compared with isoflurane, while the hemodynamics parameters were stable during operation.