地氟醚吸入麻醉对气道阻力、肺顺应性和气道压的影响

Effects of Desflurane on Airway Resistance, Pulmonary Compliance , and Airway Pressure

目的:观察地氟醚吸入麻醉时肺顺应性、气道阻力和气道压的变化。方法:60例无心肺疾患不吸烟的成年病人随机分为硫喷妥钠组(S组),异氟醚组(Ⅰ组),地氟醚组(D组)。麻醉前肌注苯巴比妥钠0.1 g。用硫喷妥钠5 mg/kg、维库溴铵地0.1 mg/kg静注后气管插管,随后连接Astiva 3000型麻醉机测定气道阻力、肺顺应性和气道压。S组插管后静注硫喷妥钠0.25 mg·kg-1·min-1,Ⅰ组和D组分别吸入异氟醚和地氟醚,并尽快将其维持在1 MAC。S组记录静注硫喷妥钠2,4,6,8,10,15 min的上述各值,其余两组分别记录达到1 MAC后2,4,6,8,10,15min的上述各值,同时记录各时间点的血流动力学指标。结果:气管插管后病人的血流动力学变化较大,给药4min后恢复到术前水平,6,8,10,15 min时部分病人的血压下降明显;S组和D组给药后各时间点的气道阻力、肺顺应性和气道压与基础值比差异没有显著性意义(P>0.05);Ⅰ组病人给药后与基础值和其他两组比较气道阻力明显下降、肺顺应性明显上升(P<0.01),气道压变化没有显著性意义(P>0.05)。结论:地氟醚麻醉对气道阻力、肺顺应性和气道压没有显著影响。

Objective: Our aim was to observe the effects of desflurane inhalation on airway resistance, pulmonary compliance, and airway pressure. Methods: Sixty adult patients without cardiac or pulmonary disease and smoking history were randomly divided into 3 groups: thiopental group (group S, n = 20) , isoflurane group (group I, n = 20) , desflurane group(group D, n = 20). Patients received phenobarbital sodium 0. 1 gram intramuscularly before anesthetized. Anesthesia was induced with thiopental (5 mg/kg) and vecuronium (0. 1 mg/kg). Patients were intubated and mechanically ventilated (Astiva 3000,Ohmeda). Airway resistance, pulmonary compliance,and airway pressure were measured. After intubated, patients in group S received thiopental (0.25 mg · kg-1 · min ) intravenously, and those in group I and D received isoflurane and desflurane 1 MAC respectively. Airway resistance, pulmonary compliance, airway pressure, and hemody-namic parameters were recorded on 2,4,6,8,10,15 minutes after the administration of thiopental in group S and the concentrations of isoflurane or desflurane reaching 1 MAC in group I and D. Results: The hemodynamic indexes varied greatly after intubation and recovered to levels before operation 4 minutes after induction. In most patients, the blood pressure decreased significantly on 6,8 ,10,and 15 minutes after intubation . The airway resistance, pulmonary compliance, and airway pressure after intubation were not significantly different from basic values in group S and D ( P > 0. 05). The airway resistance decreased and pulmonary compliance increased significantly ( P < 0. 01) in group I. The variation of airway pressure was not significant ( P > 0. 05 ). Conclusion: The airway resistance, pulmonary compliance, and airway pressure have not changed significantly during anesthesia with desflurane.