七氟醚对单肺通气期间血气和循环的影响

Effects of sevoflurane on blood gases and circulation during one-lung ventilation

目的观察七氟醚吸入麻醉在胸外科非肺部手术行单肺通气期间对病人血气和循环的影响。方法20例ASAⅠ-Ⅱ级的病人,用芬太尼2μg/kg,咪唑安定0.05mg/kg,异丙酚(2-3)mg/kg,司可林1.5mg/kg作静脉快速诱导,插入右侧双腔气管导管。用吸入1.3-2.0MAC的七氟醚,间断静注维库溴铵和芬太尼维持麻醉。于双肺通气(TLV)30min,右侧单肺通气(OLV)15min,30min,60min测定血气及血流动力学指标。结果右侧OLV期间,动脉血氧分压(PaO2)和氧饱和度(SaO2)较TLV30min时明显下降(P<0.05),但绝对值仍在正常范围内,而其他参数基本保持不变。结论在右侧OLV期间七氟醚吸入麻醉对肺内分流有影响,对机体HPV有一定的抑制作用,但不影响临床安全使用。

Objective To evaluate the effects of sevoflurane on blood gases and circulation during one-lung ventilation in non-lung procedures of thoracic surgery. Methods Twenty ASA Ⅰ - Ⅱ patients were selected in the study. Anesthesia was induced with midazolam 0.05mg ·kg^-1, fentanyl 2 μg ·kg^-1, propofol（2-3）mg·kg^-1, and succinylcholine 1.5mg·kg^-1, and double-lumen endotracheal tubes were intubated. Anesthesia was maintained with 1.3-2.0 MAC sevoflurane inhalation and intermittent iv boluses of fentanyl. Indexes of blood gases and hemodynamics were measured 30 minutes after two-lung ventilation, 15 minutes,30 minutes and 60 minutes after the right one-lung ventilation respectively. Resuha Both PaO2 and SaO2 decreased significantly during OLV than TLV （P 〈 0. 05） . There were no significant differences with respect to other indexes. Conclusion During the right OLV,sevoflurane inhalation has influences on pulmonary shunt and inhibition of hypoxic pulmonary vasoconstriction. Sevoflurane can be safely used clinically.