静吸复合麻醉对肺癌患者术中单肺通气氧合及肺内分流的影响

The Influence of One lung Ventilation on Oxygenation and Intrapulmonary Shunt in Patients with Lung Cancer Resection Under Intravenous Inhalational Anesthesia

目的探讨静吸复合麻醉对肺癌患者术中单肺通气氧合及肺内分流的影响。方法选取2016年10月—2017年10月解放军第八五医院普胸外科收治的70例肺癌手术患者作为研究对象,按照随机数字表法分为研究组(38例)和对照组(32例)。所有患者均在全麻下以开胸方式进行手术,术中采用了单肺通气。对照组的麻醉方法为全静脉麻醉,研究组为静吸复合麻醉。记录插管后15 min(T_1时刻)、单肺通气后45 min(T_2时刻)和双肺通气后15 min(T_3时刻)等。结果⑴T_1时刻,研究组与对照组的SpO_2和PaO_2差异均无统计学意义(P>0.05);T_2时刻,研究组与对照组的SpO_2和PaO_2均有所下降,但研究组下降更明显,差异具有统计学意义(P<0.05);T_3时刻,研究组与对照组的SpO_2和PaO_2均有所恢复,差异无统计学意义(P>0.05)。⑵T_1时刻,研究组与对照组的Qs/Qt差异无统计学意义(P>0.05);T_2时刻,研究组与对照组的Qs/Qt均有所增加,但研究组增加更明显,差异有统计学意义(P<0.05);T_3时刻,研究组与对照组的Qs/Qt有所恢复,差异无统计学意义(P>0.05)。结论对于肺癌患者,在术中采用静吸复合麻醉的情况下,由于HPV机制在麻醉维持阶段受到抑制,SpO_2和PaO_2较全静脉麻醉维持阶段更低,Qs/Qt更高。因此,可以认为静吸复合麻醉的安全性较全静脉麻醉稍低。

OBJECTIVE To investigate the influence of one lung ventilation on oxygenation and intrapulmonary shunt in patients with lung cancer resection under intravenous inhalational anesthesia. METHODS 70 patients with lung cancer surgery treated by general thoracic surgery in our hospital from October 2016 to October 2017 were selected as subjects, who were divided into study group（38 cases） and control group（32 cases） according to the random number table method. All patients underwent open-thorax surgery under general anesthesia with single-lung ventilation. Total intravenous anesthesia was used in the control group, and intravenous inhalational anesthesia in the study group. Oxygen swere recorded at 15 minutes after intubation（T1）, 45 minutes after one lung ventilation（T2）, 15 minutes after ventilation of both lungs（T3）. The SpO2, PaO2, and Qs/Qt at the time of T1, T2, and T3 were compared between the study group and the control group. RESULTS（1） At T1, there was no significant difference in SpO2 and PaO2 between the study group and the control group（P〈0.05）. At T2, both SpO2 and PaO2 in the study group and the control group decreased, but the study group decreased more（P〈0.05）. At T3, SpO2 and PaO2 in the study group and the control group were all recovered, which were not the statistically different（P〈0.05）.（2） At T1, there was no significant difference in Qs/Qt between the study group and the control group（P〉0.05）. At T2, the Qs/Qt in both groups increased, but the study group increased more（P〈0.05）. At T3, the Qs/Qt between the study group and the control group was restored, which were not statistically different（P〉0.05）. CONCLUSION For patients with lung cancer, in the case of inhalation combined anesthesia during surgery, SpO2 and PaO2 are lower than the total intravenous anesthesia maintenance phase, and Qs/Qt was higher, because of the mechanism of HPV suppressed during the anesthesia maintenance phase. Therefore, it could be considered that the safety of inhalation combined anesthesia was slightly lower than that of total intravenous anesthesia.