麻醉对妇科腹腔镜患者肺内分流及血气影响

Theeffectsofanesthesiaingynecologicallaparoscopicintrapulmonary shunt and blood gas

目的分析七氟醚、异氟醚与地氟醚复合异丙酚在对妇科腹腔镜手术患者肺内分流及血气的影响。方法选取我院2010年4月-2013年4月收治的192例行腹腔镜手术的妇科患者，按照患者意愿分为七氟醚、异氟醚和地氟醚组，各64例，分别接受七氟醚、异氟醚与地氟醚复合异丙酚麻醉，分析3组患者肺内血流和血气变化。结果随着插管和气腹的进行，3组患者Qs／Qt均见升高，而Pa02逐渐下降，放气后肺内分流逐渐恢复正常，地氟醚组患者肺内分流变化幅度最小（P〈0．05）；而3组患者血气水平变化相同，放气后血气水平逐渐恢复正常，地氟醚组患者血气水平变化幅度最小（P〈0．05）；3组患者气腹后均未见心律失常，肌松效果均满意，术后不适：七氟醚3例，2例咽部不适，1例肩部疼痛；异氟醚5例，4例咽部不适，1例肩部疼痛；地氟醚1例，为咽部不适。结论在今后妇科腹腔镜手术的麻醉诱导过程中，建议推广应用地氟醚复合麻醉，可得到优秀的可控性、镇痛深度，且能够保证肺内分流和血气稳定，减少并发症的发生。

Objective To analyze sevoflurane, isoflurane and desflurane and propofol in gynecologic laparoscopic operation for patients with intrapulmonary shunt and blood gas. Methods 192 cases of laparoseopie operation in our hospital from 2010 April to 2013 year in April admitted to the gynecologic patients, randomly divided into sevoflurane, isoflurane and desflurane group, 64 cases each, sevoflurane, isoflurane and desflurane were received propofol, changes of three groups of patients pulmonary blood flow and blood gas. Results With the intubation and pneumoperitoneum, three groups of patients with Qs/Qt were increased, while PaO2 decreased gradually, intrapulmonary shunt gradually returned to normal after deflation, desflurane group were intrapulmonary shunt changed minimum （P 〈 0.05） and the changes in blood gas levels were similar in three groups, blood gas levels gradually returned to normal after deflation, variation of desflurane patients with minimal blood gas levels （P 〈 0.05）; three patients had no arrhythmia after pnenmoperitonenm, on muscle relaxation effect is satisfactorY, postoperative discomfort： of the 3 eases, 2 cases of pharyngeal discomfort of sevoflurane, isoflurane, 1 cases of shoulder pain; 5 cases, 4 cases of pharyngeal discomfort, 1 cases of shoulder pain; 1 cases of desflurane, throat discomfort. Conclusion After induction of anesthesia in gynecological laparoscopic operation in the process, about the popularization and application of desflurane anesthesia, analgesia can be controllable, depth of a good, and can guarantee the stability of intrapulmonary shunt and blood gas, and reduce the occurrence of complication.