摘要
目的观察不同程度血液稀释对单肺通气全麻手术中脑氧合的影响。方法30例单纯肺叶切除术行单肺通气的患者,随机均分为血液稀释组和对照组。血液稀释组分别在单肺通气后血液稀释前(T1)、Hct达(30±1)%(T2)和Hct达(26±1)%(T3)三个不同时点,对照组则在相对应的时点同步从动脉和颈内静脉取血作血气分析和乳酸测定,并记算颈内静脉血氧饱和度(SjvO2)、动脉-颈内静脉血氧含量差(DA-jvO2)、脑氧摄取率(CERO2)和动脉-颈内静脉血乳酸含量差(DA-jvL)。结果血液稀释组在T2时SjvO2较T1时升高,DA-jvO2和CERO2较T1时降低(P<0.05);T3时与T1时比较虽有变化,但差异无统计学意义。与对照组比,血液稀释组T2时SjvO2升高,DA-jvO2和CERO2降低,差异有统计学意义(P<0.01);T3时SjvO2、DA-jvO2和CERO2差异无统计学意义。两组患者DA-jvL组内组间差异无统计学意义。结论单肺通气全身麻醉期间血液稀释到Hct达(30±1)%时脑氧合状况较佳,Hct达(26±1)%时不会影响脑氧合状况。
Objective To investigate the effects of different degree of hemodilution on encephalon oxygenation in general anesthesia patients with one-lung ventilation (OLV). Methods Thirty patients urdergoing purely pulmonary lobectomy were randomly divided into experimental group (group E)and control group (group C). During OLV, blood samples were taken from arteria radialis (a) and vena jugularis interna bulb (iv) simultaneously at the time points of before hemodilution (T1), after OLV at the time of Hct (30±1) % (T2) and the time of Hct (26±1) % (T3) in group E. The same samplings were performed in group C with OLV only. By assaying internal jugular venous oxygen saturation (SjvO2), the difference of oxygen content in arteria and internal jugular venous (DA-jvO2), cerebral extraction of oxygen(CERO2 ) and the difference of lactic acid content in arteria and internal jugular vein blood(DA-jvL), cerebral oxygenation state on different time points were ana lyzed. Results In group E, SivO2 was higher (P〈0.05), DA-jvO2 and CERO2 were lower in group E than those in group C at T2(P〈0.05) . However, SjvO2 ,DA-jvO2 and CERO2 were not markedly different between two groups at T3. Compared with group C, in group E, SjvO2 was higher, DA-jvO2 and CERO2 were lower in group E at T2 (P〈0. 01 ), SjvO2, DA-jv O2 and CERO2 were not significantly different between two groups at T3. So did the level of DA-jvL at T2 and T3. Conclusion During general anesthesia in one-lung mechanical ventilation patients, cerebral oxygenation is better during hemodilu tion of Hot to (30±1) % ,on which hemodilution of Hct (26±1) % has no effect.
出处
《临床麻醉学杂志》
CAS
CSCD
2007年第1期9-11,共3页
Journal of Clinical Anesthesiology
基金
国家自然科学基金资助项目(编号:30471661)
关键词
单肺通气
血液稀释
全麻
脑氧合
One-lung ventilation
Hemodilution
General anesthesia
Cerebral oxygenation