七氟醚静吸复合麻醉和全凭静脉麻醉在单肺通气手术中的临床研究

Comparison of sevoflurane-remifentanil compound Anesthesia and remifentanil total Intravenous anesthesia for one lung ventilation

目的探讨七氟醚静吸复合麻醉和瑞芬太尼静脉麻醉在胸外科单肺通气手术中的麻醉效果,及其对患者血流动力学和血气的影响。方法 76例ASAⅠ～Ⅱ患者,随机分为七氟醚组(S)和瑞芬太尼组(R)。两组均用咪唑安定0.05mg/kg,舒芬太尼2～3ug/kg,丙泊酚1.5～2mg/kg,维库溴铵0.1mg/kg静脉快速诱导,插入双腔支气管导管,术中均持续静脉靶控输注丙泊酚、瑞芬太尼维持麻醉;S组在插管后持续吸入1.0～2.5%七氟醚,R组全凭静脉麻醉。分别记录T1、T2、单肺通气15min(T3)、单肺通气30min(T4)以及单肺通气结束前1min(T5)等时间点的HR、MAP、CVP、SPO2、PETCO2以及T2～T5各时刻抽取静脉血和动脉血做血气分析,并根据血气分析结果计算肺内分流率(QS/QT)。结果两组患者各时间点HR、MAP以及CVP组间比较差异无显著性意义(P>0.05),两组患者麻醉后MAP均显著低于T1(P<0.05),术中升压、降压药物的使用率S组均低于R组(P<0.05);T3、T4、T5时刻肺内分流率较T2时刻显著增加,PaO2较T2时刻显著下降,T5时刻的PaO2较T4时刻有所回升。结论七氟醚静吸复合麻醉和瑞芬太尼静脉麻醉在胸外科单肺通气手术中都能提供满意的麻醉效果;在术中前者能更好的维持循环的稳定;后者对肺内分流的影响较小,但两者都不影响在临床中的安全应用。

Objective To investigate the effects of the sevoflurane-remifentanil compound anesthesia and remifentanil to- tal intravenous anesthesia for one lung ventilation （OLV） on intrapulmonary shunt and blood gas. Methods Seventy-six ASAⅠ～Ⅱ patients were randomly divided into two groups： Sevollurane group（ S group） and remifentanil group（ R group） ,Anesthesia was induced with midazolam 0. 05mg/kg, sufentany 2 ～ 3ug/kg, propofol （ 1.5 ～ 2. 0 ） mg/kg, and vecuronium 0. lmg/kg, and double-lumen endotracheal tubes were intubated, in S group Anesthesia maintained with 1.0% ～ 2.5% Sevoflurane combined with a target controlled infusion of remifentanil and propofol, R group maintained with total intravenous anesthesia. HR, MAP, CVP, S p 02 ,PETCO2 ,BIS and blood gas of arterial blood and mixed venous blood were recorded before operation （T1） ,1 minute before OLV （T2 ） ,15 minute after OLV（T3 ） ,30 minute after OLV （T4） and I minute before OLV was over （T5 ）. Q s/QT was calculat- ed. Results ＇llaere is no significant difference between HR, MAP, CVP, BIS at time points in the two groups （ P 〉 0. 05. MAP was significantly lower than preoperative （TI ） （P 〈 0. 05 ）. The incidence hypertension and the utilization of in group S was significant- ly lower than group R. there was significant difference between the two groups（ P 〈 0. 05 ）. intrapuhnonary shunt （ Qs/QT ） in- creased significantly and PaO2deereased significantly at T3 ,T4 and Tscompared with those at T2 （P 〈0. 01 ）, and PaO, increased significantly at Tscompared with those at T4 （ P 〈 0. 05 ）. Conclusion Sevoflurane-remifentanil compound anesthesia and remifen- tanil total intravenous anesthesia both provided satisfactory anesthesia for one lung ventilation（OLV） on intrapulmonary. In control- ling the hypertension and the utilization,sevollurane-remifentanil compound anesthesia is superior to remifentanil total intravenous anesthesia;during the OLV sevoflurane inhalation combined with propofol has more influencer than renfifentanil total intravenous anesthesia on intrapulmonary shunt. But can be safely used clinically.