七氟烷、丙泊酚分别联合芬太尼对肺部手术患者血气以及脑氧饱和度的影响

EFFECT OF SEVEN ISOFLURANE COMBINED WITH FENTANYL AND PROPOFOL COMBINED WITH FENTANYL ON BLOOD GAS AND CEREBRAL OXYGEN SATURATION IN PATIENTS WITH LUNG OPERATION

目的研究七氟烷、丙泊酚分别联合芬太尼对肺部手术患者血气分析以及脑氧饱和度的影响。方法选取该院胸外科住院的择期肺切除手术患者68例,随机分为二组。其中七氟烷组34例,采用咪达唑仑0.04mg/kg、维库溴铵0.15mg/kg、芬太尼4μg/kg静脉诱导联合七氟烷麻醉;丙泊酚组34例,采用同种静脉诱导联合丙泊酚麻醉。麻醉诱导前(T1)、机械通气后15min(T2)、单肺通气后30min(T3)、手术结束后15min(T4),采集桡动脉血液,进行血气分析,计算Qs/Qt值;采用脑氧饱和度监护仪测定T1、T2、T3、T4四个时间点患者的脑氧饱和度(rSO2),计算均值;采用简易精神状态量表(mini-mental state examination,MMSE)分别对患者麻醉前、应答后1、6、24、72h进行评分。结果 1血气分析指标比较,二组患者的SO2均在90%以上,相同时间点二组PO2比较差异无统计学意义,在同组间比较T3<T2,差异有统计学意义(P<0.05);同组比较,丙泊酚组Qs/Qt的T3>T2,差异有统计学意义(P<0.05);T3时,丙泊酚组Qs/Qt明显大于七氟烷组,差异有统计学意义(P<0.05);2脑氧饱和度测定比较显示,与T1比较,T2时二组患者的rSO2均明显升高,差异有统计学意义(P<0.05),T3时丙泊酚组rSO2明显降低,差异有统计学意义(P<0.05);在T3时,丙泊酚组的rSO2明显低于七氟烷组,差异有统计学意义(P<0.05);3认知功能比较显示,麻醉结束后二组认知功能均有所改善,与丙泊酚组相比,七氟烷组MMSE评分在麻醉结束后6h、24h、72h明显改善,差异有统计学意义(P<0.05)。结论七氟烷麻醉在肺部手术中降低肺内分流,保持脑氧饱和度,防止脑神经损害方面的效果比丙泊酚更明显,值得临床推广。

Objective To study the effect of propofol, seven halothane combined with fentanyl respectively on Mood gas and cerebral oxygen saturation of patients with lung operation. Methods Sixty - eight pa- tients undergoing lung resection operation in author＇s hospital were randomly divided into two groups. Of which seven halothane group 34 cases, treated with 0. 04mg/kg of midazolam, vecuronium bromide 0. 15mg/kg, fentanyl 4μg/kg intravenous induction combined with seven halothane anesthesia; Propofol group 34 cases, induced by allogenic vein combined with propofol anesthesia. The radial artery blood was collected, blood gas analysis was performed and the Qs/Qt value was calculated at before induction of anes- thesia （T1）, after 15 minutes of mechanical ventilation （T2）, half an hour after one lung ventilation （T3）, 15 minutes after the end of operation （T4）, respectively; Cerebral oxygen saturation[ rSO2 ） was determina- ted at T1 , T2, T3, T, four time points by cerebral oxygen saturation monitor. Mini- Mental State exami- nation{MMSE} score was used to evaluate anesthesia efficency of patients before anesthesia, after answer- ing 1 hours, 6 hours, 24 hours, 72 hours. Results The index of blood gas analysis, two groups of patients with SO2 were more than 90%, there was no significant difference between the two groups at the same time PO2. In the same group, the index was T3〈 T2, but whose Qs/Qt was T3〉 T2 in propofol group, the difference was statistically significance （P〈0.05）. At Ta , Qs/Qt of propofol group was significantly lar- ger than seven halothane group, the difference was statistically significant （P〈0.05）. Compared with T1 , cerebral oxygen saturation at T2 of two groups of patients with rSO2 was increased significantly, rSO 2 of propofol group at T3was decreased than seven halothane group significantly, the difference was statistically significant （P〈0.05） ; The cognitive function of a two groups fter anesthesia was improved, compared with propofol group, seven halothane group MMSE score at 6 hours, 24 hours, 72 hours were significantly improved at the end of anesthesia, the difference was statistically significant （P〈0.05）. Conclusion Sev- en halothane anesthesia can decrease intrapulmonary shunt in lung operation, keep the cerebral oxygen sat- uration, prevent brain damage,it is more effective than propofol, is worth the clinical promotion.