单、双肺通气时七氟醚呼气末浓度与脑电双频指数的相关性分析

Concentration of Expired Sevoflurane and BIS Correlation Analysis between OLV and TLV

目的 观察单肺通气（OLV）和双肺通气（TLV）时七氟醚呼气末浓度对脑电双频指数及血流动力学的影响.方法全身麻醉下行开胸食管癌手术40例,随机分成A,B,C,D4个组.全麻诱导后,插入双腔支气管导管控制呼吸,调节七氟醚挥发罐刻度使4组患者七氟醚呼气末浓度（CET-Sev）分别为0.8,1.0,1.2,1.4MAC.麻醉前（T1）、TLV（开胸前CET-Sev稳定后）15min（T2）、OLV（开胸后CET-Sev稳定后）15min（T3）、30min（T4）、60min（T5）记录术中的BIS,HR,MAP.结果 单肺通气后4组的BIS,HR,MAP明显高于双肺通气（P＜0.05）.单肺通气时15min,30min,60min,BIS,HR,MAP差异无显著性（P＞0.05）.随CET-Sev 的增加TLV和OLV时BIS,HR,MAP逐渐下降（P＜0.05）.TLV15min与OLV15min的BIS与CET-Sev呈线性负相关（r=-0.987,-0.983,P均＜0.05）.结论 单肺通气与双肺通气在合适的麻醉深度（40＜ BIS ＜65）时CET-Sev范围不同：双肺通气时CET-Sev范围是0.8～1.0 MAC,单肺通气时CET-Sev范围是1.0～1.2MAC.与双肺通气相比,单肺通气吸入七氟醚时应适当提高七氟醚吸入浓度.

Objective To compare BIS, MAP, and HR of sevoflurane inhalation anesthesia between one-lung ventilation and two- lung ventilation when end-tidal concentration of sevoflurane is different. Methods Forty patients undergoing esophageal cancer resection were randomly divided into A, B, C, D group. After induction of general anaesthesia, all of four groups inserted double-lumen endobronchial tube to control breath, adjust concentration of expired sevoflurane （CET-Sev） of A, B, C, D group was 0.8,1.0,1.2,1.4MAC. MAP, HR and BIS were monitored and recorde before anesthesia { T1 ）, TLV （before the operator opened the chest wall and CET-Sev after the stable） 15min （ T2 ） ,OLV （ after the operator opened the chest wall and CET-Sev after the stable） 15min（ T3 ） ,30min（ T4 ） and 60min（ T5 ）. Results After one-lung ventilation, four groups of BIS, HR, MAP was obviously higher than that of the two-lung ventilation （ P 〈 0.05 ）. One-lung ventilation 15 min,30min,60min, BIS, HR, MAP no significant difference （ P 〉 0.05 ）. When the increasing of the CET-Sev, TLV and OLV BIS, HR, MAP was decreasing（ P 〈0.05 ）. TLV15min and OLV15min BIS and CET-Sev was the linear negative correlation（ r = - 0. 987, - 0. 983 ,P 〈 0. 05 ）. Conclusion One-lung ventilation and two-lung ventilation in the appropriate depth of anesthesia （40 〈 BIS 〈 65 ） CET-Sev range is different：Two-lung ventilation CET-Sev 0.8 - 1.0 MAC ,One-lung ventilation CET-Sev 1.0 - 1.2 MAC.