比较地氟醚与异丙酚在电视胸腔镜手术中对病人氧合的影响

Effects of desflurane and propofol on systemic oxygenation in patients undergoing one-lung ventilation during video-assisted thoracoscopic surgery

目的 比较地氟醚和异丙酚在电视胸腔镜手术单肺通气中对病人的氧合影响。方法 择期行电视胸腔镜手术病人 2 0例 ,ASA ～ 级 ,随机分为地氟醚组 (D组 )和异丙酚组 (P组 ) ,每组10例。麻醉诱导 :P组或 D组分别用芬太尼 4μg· kg- 1、维库溴铵 0 .1m g· kg- 1、琥珀胆碱 10 0 mg,异丙酚 2 m g· kg- 1 (P组 )或 2 .5 %硫喷妥钠 5 mg· kg- 1 (D组 ) ,以 2～ 8m g· kg- 1· h- 1异丙酚 (P组 )或 2 %～ 4%地氟醚 (D组 )、芬太尼、维库溴铵维持麻醉。静脉诱导后经口腔插入 Carlen双腔支气管导管。监测术中 MAP及 HR的变化 ,并分别于术前、TL V30 min、OL V30 min、OL V6 0 m in取桡动脉血做血气分析。结果 两组病人均于单肺通气后 Pa O2 虽明显下降 (P<0 .0 5 ) ,但 Pa O2 >6 0 mm Hg,组间无显著性差异。D组术中 MAP明显低于术前 ,而 P组无显著性变化。

Objective To compare the effects of desflurane and propofol on systemic hemodynamics and arterial oxygenation undergoing one-lung ventilation (OLV) during video-assisted thoracoscopic surgery (VATS)Methods Twenty patients,ASA physical status Ⅱ or Ⅲ, scheduled for elective VATS undergoing OLV , were prospectively randomized into two groups : desflurane group(group D,n=10) and propofol group (group P,n=10) Anesthesia was induced with intravenous propofol 2mg·kg -1(group P) or thiopental 5 mg·kg -1( group D) combined with intravenous fentanyl 4μg·kg -1 ,vecuronium 01mg·kg -1 and succinylcholine 100mg , and was maintained with infusion of propofol at rate of 2-8 mg· kg -1·h -1 (group P) or inhalation of desflurane 2%-4% (group D) The Carlen double-lumen endobronchial tube was intubated to ventilated mechanically with 100% oxygen MAP and HR were monitored during the entire procedures, and blood gas analysis was made before operation, 30 min following two-lung ventilation, 30 min and 60 min following OLV in both groups,respectively Results PaO 2 were decreased significantly following OLV in both groups(P<005),but PaO 2 was more than 60mmHg,there was no significant difference between both groups During the operation,MAP was decreased significantly in group D (P<001), but remained unsignificant change in group P (P>005)Conclusions Desflurane can be used as safely as propofol with one-lung ventilation during video-assisted thoracoscopic surgery