复合麻醉对OLV患者肺内分流和动脉氧合的影响

Effects of combined anesthesia on pulmonary shunt and arterial oxygenation in patients undergoing OLV

目的研究复合麻醉对单肺通气(OLV)患者肺内分流和动脉氧合的影响。方法2016年7月至2018年12月接受OLV的患者92例作为研究对象,通过随机抽签法分成复合组及全麻组,每组46例。全麻组予以全麻处理,复合组采用硬膜外阻滞复合全麻处理。比较2组麻醉诱导后双肺通气(T1)、单肺通气30 min(T2)、单肺通气60 min(T3)时的肺内分流和动脉氧合情况,麻醉前10 min、气管插管时、插管后5 min、术毕10 min时的血流动力学水平,不良反应发生情况,苏醒时间、拔管时间。结果T2、T3时复合组及全麻组的PaO2水平均低于T1时,且T2、T3时复合组及全麻组的Qs/Qt水平高于T1时(P<0.05);但复合组及全麻组在T1、T2、T3时PaO2、PaCO2、Qs/Qt水平对比均不明显(P>0.05)。气管插管时复合组MAP水平低于全麻组,插管后5 min复合组MAP水平高于全麻组;且气管插管时、插管后5 min复合组HR水平低于全麻组(P<0.05)。复合组不良反应发生率低于全麻组(P<0.05)。复合组苏醒时间、拔管时间均低于全麻组(P<0.05)。结论复合麻醉对OLV患者肺内分流和动脉氧合均不会造成严重影响,且有利于维持血流动力学的紊乱,降低麻醉相关不良反应的发生风险,缩短苏醒时间、拔管时间,值得推广应用。

Objective To investigate the Effects of combined anesthesia on pulmonary shunt and arterial oxygenation in patients undergoing one-lung ventilation(OLV).Methods A total of 92 patients who underwent OLV in our hospital from July 2016 to December 2018 were enrolled as research subjects,who were divided into combination anesthesia group and general anesthesia group according to random lottery,with 46 cases in each group.The patients in general anesthesia group received general anesthesia,however,the patients in combination anesthesia group received epidural blocking combined with general anesthesia.The intrapulmonary shunt and arterial oxygenation after anesthesia induction(T1),30min(T2),60min(T3),and 10min before anesthesia,5min after endotracheal intubation,10min after intubation,hemodynamics,adverse reactions,recovery time,and extubation time were observed and compared between the two groups.Results The levels of PaO2 at T2 and T3 in both groups were significantly lower than those at T1,however,the levels of Qs/Qt at T2 and T3 in both groups were significantly higher than those at T1(P<0.05).However,there were no significant differences in the levels of PaO2,PaCO2 and Qs/Qt at T1,T2 and T3 between the two groups(P>0.05).Moreover the MAP levels in combination anesthesia group were significantly lower than those in general anesthesia group during endotracheal intubation,however,the MAP levels at 5min after endotracheal intubation in combination anesthesia group were significantly higher than those in general anesthesia group,moreover,the HR levels during endotracheal intubation and at 5min after endotracheal intubation in combination anesthesia group were significantly lower than those in general anesthesia group(P<0.05).In addition the incidence rate of adverse reactions in combination anesthesia group was significantly lower than that in general anesthesia group(P<0.05),and the palinesthesia time and extubation time in combination anesthesia group were significantly shorter than those in general anesthesia group(P<0.05).Conclusion The combined anesthesia has no serious effects on pulmonary shunt and arterial oxygenation in patients undergoing OLV,which is beneficial to improve hemodynamic disorder,reduce the risk of anaesthesia-related adverse reactions,and shorten recovery time and extubation time,therefor,it is worthy of clinical application and promotion.