七氟烷预处理或后处理对胸外科手术单肺通气患者肺内分流的影响

The effect of sevoflurane pretreatment or aftertreatment on intrapulmonary shunt for patients with one lung ventilation during thoracic surgical procedures

目的探讨七氟烷预处理或后处理对胸科手术单肺通气(OLV)患者肺内分流的影响。方法 80例择期行开胸手术OLV的患者分为4组:全凭静脉组(P组),七氟烷预处理组(S1组),七氟烷后处理组(S2组),七氟烷全程吸入组(S3组),每组20例。在麻醉诱导前(T0)、OLV前(T1)即七氟烷预处理30min后、OLV 30min(T2)、OLV 60min(T3)、OLV结束前(T4)、OLV结束后30min(T5)采集桡动脉及右心房血样行血气分析,计算肺内分流率(Qs/Qt),同时记录血流动力学指标及相关的临床数据。结果 OLV期间,4组患者氧分压较双肺通气时明显降低(P<0.05),但4组间的氧分压比较差异无统计学意义(P>0.05);4组患者的肺内分流较双肺通气时明显增加(P<0.05),但S1、S2、S3组的肺内分流较P组低(P<0.05),S1、S2、S3组间差异无统计学意义(P>0.05)。结论七氟烷预处理、后处理全程处理能降低OLV患者肺内分流,但3种处理方式之间无显著差异,也不能明显提高动脉氧分压。

Objective To study the effect of sevoflurane pretreatment or aftertreatment on intrapulmonary shunt for patients with one lung ventilation（OLV）during thoracic surgical procedures .Methods 80 ASA I or II patients underwent thoracic surgery with OLV were randomly divided into four groups（n= 20 for each）：（1）Propofol group（group P）;（2）Sevoflurane pretreatment group（group S1）;（3）Sevoflurane aftertreatment group（group S2）;（3）Sevoflurane whole-treatment group（group S3） .Blood sam-ples were taken from radial artery and right atrial blood before induction of anesthesia（baseline T .0） ,before OLV（sevoflurane pre-treatment 30 min ,T1） ,after OLV 30 ,60 min and before the end of OLV（T2-T4）and after the end of OLV（T5）for measurement of blood gases and calculation of Qs/Qt .The indexs of hemodynamics and relative clinical data were recorded .Results Arterial oxy-gen pressure of the four groups for OLV significantly reduced ,when compared with double lung ventilation（P〈0.05） ,but there was no significant difference among the four groups（P〉0.05） .Intrapulmonary shunt of the four groups for OLV significantly in-creased ,when compared with double lung ventilation（P〈0.05） ,but intrapulmonary shunt of S1 ,S2 and S3 groups significantly de-creased ,when compared with P group ,and there was no significant difference for S1 ,S2 and S3 groups（P〉0.05） .Conclusion Sevoflurane can decrease intrapulmonary shunt for patients during OLV ,but there is no significant difference for pretreatment or af-tertreatment or whole treatment and do not increase arterial oxygen pressure .