麻醉深度监测下比较异丙酚、异氟醚在单肺通气时对肺内分流的影响

Comparison of the effects of propofol and isoflurane on intrapulmonary shunt during one-lung ventilation

目的:在麻醉深度监测下以异丙酚为对照观察异氟醚在单侧肺通气时对肺内分流的影响。方法:择期行右侧开胸的食管癌患者28例,ASAⅠ～Ⅱ级,随机分为异氟醚组和异丙酚组,每组14例。双腔支气管置管成功后,分别以异氟醚、异丙酚维持麻醉,使麻醉深度AAI值维持在预定的20～30之间。手术前平卧位双肺通气20min,平卧位左侧单肺通气40min,分别采集动脉血和混合静脉血行血气分析,计算肺内分流率。结果:在单肺通气后,两组肺内分流率增加明显(P<0.05),但组间比较无统计学差异(P>0.05)。结论:排除手术、体位等影响,在相同的麻醉深度下,异氟醚在单肺通气后对肺内分流的影响与异丙酚无差别。

Objective：To study the effects of propofol and isoflurane on hypoxic pulmonary vasoconstriction（HPV） during one-lung ventilation（OLV）.Methods：Twenty-eight esophagus carcinoma patients,ASA Ⅰ to Ⅱ,scheduled for selective right thoracotomy,were randomly assigned into two groups：group P（n =14） and group I（n = 14）.Anesthesia was induced with intravenous etomidate 0.25 mg·kg-1,fentanyl 4 μg·kg-1 and atracurium 0.5 mg·kg-1.Left-sided double-lumen endobronchial tube was intubated orally.Then anesthesia maintained with infusion of propofol in group P,or with isoflurane inhalation in group I.The speed of infusion of propofol or concentration of isoflurane was adjusted according to the AAI value（20 ～ 30）.MAP and HR were monitored during the procedure.Arterial and mixed venous blood sample were taken for blood gas analysis and intrapulmonary shunt（Qs/Qt） calculations before surgery,20 min after two-lung ventilation,40 min after OLV in two groups,respectively.Results：After OLV,Qs/Qt in group P and group I all increased（P 0.05）,but there was no significat difference in Qs/Qt and PaO2 at two time points among the two groups（P 0.05）.Conclusion：AAI value maintained at 20 ～ 30,the effects of isoflurane on arterial oxygeation and pulmonry shunt fraction are similar to those of propofol during OLV ventilation.