舒芬太尼复合异丙酚靶控输注对单肺通气肺内分流的影响

Effects of general anesthesia by TCI sufentanil and propofol on intrapulmonary shunt during one-lung ventilation

目的:研究舒芬太尼-异丙酚靶控静脉麻醉与异氟醚麻醉对单肺通气(One-lung ventilation,OLV)肺内分流和肺顺应性(Dynamic compliance of lung,Cdyn)的影响。方法:择期行中、下段食管癌根治手术患者20例,ASAⅠ～Ⅱ级,随机分为2组(n=10):舒芬太尼-异丙酚组(SUF组),靶控输入效应室浓度为0.5 ng/ml舒芬太尼和3μg/ml异丙酚麻醉;异氟醚组(ISO组),吸入1%～3%异氟醚维持麻醉。分别于麻醉后双肺通气30 min(T0)、单肺通气30 min(T1)、60 min(T2)、90 min(T3)等4个时间点经桡动脉、颈内静脉采血做血气分析,计算肺内分流率(Qs/Qt)和Cdyn。结果:与T0时点相比,2组Qs/Qt在T1～T3时点显著增加(P<0.05),Cdyn在T1～T3时点显著降低(P<0.05);与ISO组相比,SUF组Qs/Qt在T1～T3时点降低(P<0.05),Cdyn在T1～T3时显著增加(P<0.05)。与T0时点相比,PaO2在OLV后明显下降(P<0.05),组间相比,差异无统计学意义(P>0.05)。结论:舒芬太尼-异丙酚靶控静脉麻醉在开胸手术施行OLV期间可减少肺内分流,增加Cdyn,但对PaO2的影响不明显。

Objective：To investigate the difference effects in intrapulmonary shunt and pulmonary dynamic compliance between sufentanil-propofol by target-controlled infusion and isoflurane during one-lung ventilation.Methods：Twenty ASA ⅠorⅡ patients undergoing radical esophagus cancer resection via left thoracotomy were randomly divided into 2 equal groups（n=10 each）：the sufentanil and propofol group（SUF） and the isoflurance group（ISO）.In SUF group anesthesia was maintained with TCI of sufentanil and propofol（targeting effect-site concentration was set at 0.5 ng/ml and 3（g/ml）;In ISO group,anesthesia was maintained with isoflurance.Arterial and pulmonary blood gases were analyzed 30 min after TLV was started（T0）,and 30,60,90 min after OLV was started（T1,T2,T3）.The intrapulmonary shunt fraction（Qs/Qt） and pulmonary dynamic compliance（Cdyn） was calculated at T0-T3.Results：The PaCO2 and pH were within normal range in both groups.Qs/Qt was significantly increased while PaO2 and Cdyn was significantly decreased during operation（from T1 to T3）as compared to baseline values（T0）,but Qs/Qt decreasing while PaO2 was increasing from T2-T3 in both groups.Qs/Qt was significantly lower in SUF group than in ISO group at each interval（T1-T3）,Cdyn was significantly high in SUF group than ISO group at each interval（T1-T3）but there no significant difference in PaO2 at T2-T3 between the two groups.Conclusion：Compared with isoflurane anesthesia,there is less intrapulmonary shunt and high pulmonary dynamic compliance during OLV under general anesthesia with sufentanil-propofol,but the difference is not significant enough to affect PaO2.