七氟醚吸入或丙泊酚静脉麻醉对单肺通气期肺内分流的影响

Effect of sevoflurane or propofol anesthesia on intrapulmonary shunting during one-lung ventilation

目的观察七氟醚、丙泊酚对单肺通气(OLV)期出现的低氧性肺血管收缩(HPV)和肺内分流(Qs/Qt)的影响。方法ASAⅡ～Ⅲ级行OLV的肺癌、食管癌患者36例,年龄30～61岁,随机均分为两组,分别采用吸入七氟醚(A组)或静脉丙泊酚诱导(B组),快速行双腔支气管导管插管。术中以吸入3%～5%的七氟醚或静脉靶控2.0～3.0μg/ml丙泊酚维持麻醉。于双肺通气(TLV)15 min、OLV15 min、OLV30 min、恢复TLV15 min时,取动脉血和混合静脉血行血气分析,计算Qs/Qt值。记录血流动力学指标。结果与TLV时相比,两组OLV期的PaO2显著下降,Qs/Qt明显增加(P<0.01)。两组OLV时的Qs/Qt无明显差异。结论七氟醚吸入或丙泊酚静脉麻醉OLV时均有一定程度的PaO2下降和Qs/Qt增加。

Objective To compare the effects of sevoflurane inhalation and propofol intravenous anesthesia on hypoxic pulmonary vasoconstriction（HPV） and intrapulmonary shunt fraction（Qs/Qt）during one-lung ventilation（OLV）.Methods Thirty six patients undergoing selective thoracic operation were randomly divided into two groups with 18 cases each.Sevoflurane 3%-5% was inhaled in group A and propofol in a target concentration of 2.0-3.0 μg/ml in group B was used intravenously.The arterial and mixed venous blood were taken for blood gas analysis before induction,at 15 min after two-lung ventilation（TLV）,at 15 min and 30 min after OLV and at 15 min after recovering TLV.The Qs/Qt was calculated.Results Compared with those during TLV in two groups,PaO2 decreased and Qs/Qt increased significantly during OLV（P0.01）.There was no significant difference in Qs/Qt during OLV between two groups.Conclusion There is a certain degree of decrease of PaO2 and increase of Qs/Qt during DLV in patients under anesthesia with sevoflurane inhalation or intravenous propofol anesthesia.