比较地氟醚与异丙酚对单肺通气时肺内分流的影响

To compare the Effect of Desflurane and Propofol on Intrapulmonary Shunt during One-lung Ventilation

目的以异丙酚作对照观测地氟醚对单侧肺通气时低氧性肺血管收缩的影响。方法择期行左侧开胸的成年手术患者20例，AsAⅠ～Ⅱ级，随机分为丙泊酚组（P组）、0．5MAC地氟醚组（D组），每组10例。分别用咪唑安定0．2mg／kg（D组）、丙泊酚3μg／ml靶控输注（P组），及芬太尼4μg／kg和罗库溴铵0．9mg／kg行静脉诱导，经口插入Mallinckrodt右双腔支气管导管。以3％地氟醚（D组）、丙泊酚（P组，以血浆靶浓度为3ug／ml速度输注）、芬太尼、罗库溴铵维持麻醉。于双肺通气15min（TLV-15）、右单肺通气15min（OLV-15）、右单肺通气30min（OLV-30）时取足背动脉血和右心房静脉血做血气分析，计算Qs／Qt。结果单肺通气后，D组和P组Qs／Qt增加明显（P〈0．05），但OLV-1时D组Qs／Qt增幅比P组小36％（P〈0．05）：而在OLV-30时D组Qs／Qt增幅比P组小39％（P〈0．05）。两组单肺通气后PaO2降幅均超过40％（P〈0．01）。结论与异丙酚比较，0．5MAC地氟醚对单肺通气时低氧性肺血管收缩影响轻微。

Objective To study the effect of desflurane on hypoxic pulmonary vasoconstriction （HPV） during one-lung ventilation （OLV）. Methods Twenty patients, ASA Ⅰ to Ⅱ, scheduled for selective left thoracotomy, were randomly assigned into one of two groups： group P （n=10） and group D （n=10）. Anesthesia was induced with intravenous midazolam 0.2mg/kg, fentanyl 4 μg/kg and rocuronium 0.9 mg/kg in group D, while with intravenous propofol 3 μg/ml, fentanyl 4 μg/kg and rocuronium 0.9 mg/kg in group P. Right-sided double-lumen endobronchial tube （Mallinckrodt） was intubated orally. Then anesthesia was maintained with target-controlled infusion of propofol to keep plasma concentration of 3 μg/ml, or with desflurane 3% inhalation in group D. The other drugs used in two groups for anesthesia maintenance are fentanyl and rocuronium. MAP and HR were monitored during the full procedure. Arterial and mixed venous blood sample were taken for blood gas analysis and intrapulmonary shunt （Qs/Qt） calculations before surgery, 15 min after two-lung ventilation, 15 min and 30 min after OLV in two groups, respectively. Results After OLV, Qs/Qt in group D and group P all increased （P〈0. 05）.Furthermore, in OLV-1 the increase in Qs/Qt of group D was 36% less than that of group P （P〈0.05） and in OLV-2 the increase in Qs/Qt of group D was 39% less than that of group P （P〈0.05）. The decreases in PaO2 were over 40% following OLV in all of the three groups （P〈0.01）.Conclusion Desflurane 0.5MAC affects HPV during OLV slightly.