CAJ | 학술논문

目的观察全凭静脉麻醉对胸腔镜手术患者单肺通气期间肺内分流和动脉血氧合的影响.方法选择40例择期行胸腔镜手术的患者,随机分成两组(n=20):全凭静脉麻醉组(A组)和静吸复合麻醉组(B组).全麻诱导插管后,A组以异丙酚靶控输注,B组以七氟醚吸入,维持BIS在40～60,PetCO2在30～35 mmHg范围内.观察并记录患者侧卧位双肺通气10 min( TLV)、侧卧位单肺通气15 min(OLV+ 15)、30 min( OLV+ 30),60 min( OLV+ 60)各时间点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)和平均气道压(Paw)；在相应时间点抽取动脉血和右心房血进行血气分析,计算肺内分流率(Qs/Qt)；观察并记录患者发生低血压、心动过缓、低氧血症、苏醒延迟及苏醒期躁动等不良反应的发生情况.结果在OLV期间,两组患者的Qs/Qt明显增加,B组大于A组(34.2±5 vs 28.8 ±2;38.4±8 vs32.1±6;37.1±2 vs 29.5±2)；两组患者的PaO2明显降低,但A组PaO2均大于B组(177±88 vs 125±63;150±65 vs 110±67;188±69 vs 128±52),差异有统计学意义(P＜0.05).在OLV后15 min、30 min两时间点,A组患者的MAP低于B组(72±10 vs 88±14;74±12 vs 89±10),差异有统计学意义(P＜0.05).A组低血压、苏醒延迟的发生率高于B组(10例vs 4例；9例vs 2例),B组苏醒期躁动的发生率高于A组(9例vs 3例),差异有统计学意义(P ＜0.05).结论与七氟醚静吸复合麻醉比较,异丙酚全凭静脉麻醉能有效减少胸腔镜手术患者单肺通气期间的肺内分流,改善动脉血氧合,有利于低氧血症的预防.
목적 관찰전빙정맥마취대흉강경수술환자단폐통기기간폐내분류화동맥혈양합적영향.방법 선택40례택기행흉강경수술적환자,수궤분성량조(n=20):전빙정맥마취조(A조)화정흡복합마취조(B조).전마유도삽관후,A조이이병분파공수주,B조이칠불미흡입,유지BIS재40～60,PetCO2재30～35 mmHg범위내.관찰병기록환자측와위쌍폐통기10 min( TLV)、측와위단폐통기15 min(OLV+ 15)、30 min( OLV+ 30),60 min( OLV+ 60)각시간점적평균동맥압(MAP)、심솔(HR)、맥박혈양포화도(SpO2)화평균기도압(Paw)；재상응시간점추취동맥혈화우심방혈진행혈기분석,계산폐내분류솔(Qs/Qt)；관찰병기록환자발생저혈압、심동과완、저양혈증、소성연지급소성기조동등불량반응적발생정황.결과 재OLV기간,량조환자적Qs/Qt명현증가,B조대우A조(34.2±5 vs 28.8 ±2;38.4±8 vs32.1±6;37.1±2 vs 29.5±2)；량조환자적PaO2명현강저,단A조PaO2균대우B조(177±88 vs 125±63;150±65 vs 110±67;188±69 vs 128±52),차이유통계학의의(P＜0.05).재OLV후15 min、30 min량시간점,A조환자적MAP저우B조(72±10 vs 88±14;74±12 vs 89±10),차이유통계학의의(P＜0.05).A조저혈압、소성연지적발생솔고우B조(10례vs 4례；9례vs 2례),B조소성기조동적발생솔고우A조(9례vs 3례),차이유통계학의의(P ＜0.05).결론 여칠불미정흡복합마취비교,이병분전빙정맥마취능유효감소흉강경수술환자단폐통기기간적폐내분류,개선동맥혈양합,유리우저양혈증적예방.
Objective To observe the effect of total intravenous anesthesia (TIVA) on intrapulmonary shunt fraction and arterial oxygenation during one-lung ventilation (OLV) for thoracoscope surgery.Methods Forty patients scheduled for thoracoscope surgery were randomly assigned to two groups ( n =20),group of TIVA (A) and group of intravenous anesthesia combined with inhalational anesthesia(B).After inducing and intubating,patients were assigned to maintenance of anesthesia with propofol ( group A)or with sevoflurane ( group B) in order to maintain a BIS between 40 and 60.Mean arterial pressure (MAP),heart rate (HR),SpO2 and Paw were measured in four phases,always in the lateral position,10min after beginning two-lung ventilation (TLV),15 min after beginning OLV (OLV + 15 ),30 rain after beginning OLV ( OLV + 30) and 60 min after beginning OLV ( OLV + 60).Blood samples were drawn simultaneously and analyzed within 5 min.The Qs/Qt at each phase was calculated.Adverse events including hypotension,bradycardia,hypoxemia,delayed emergence and restlessness in recovery period were recorded.Results In all patients,a decrease in PaO2 and an increase in the Qs/Qt occurred during OLV were observed.But PaO2 values in group A were significantly higher than those in group B ( 177 ±88 vs 125 ±63;150 ±65 vs 110 ±67;188 ±69 vs 128 ±52) ( P ＜0.05).The Qs/Qt in group B was significantly higher than those in group A (34.2 ±5 vs 28.8 ±2;38.4 ±8 vs 32.1 ±6;37.1 ±2 vs 29.5 ±2,P ＜0.05).MAP values in group A were significantly lower than those in group B at the phase:OLV + 15 and OLV +30(72 ± 10 vs 88 ± 14;74 ± 12 vs 89 ± 10) ( P ＜ 0.05 ).The incidence of hypotension and delayed emergence in group A was higher than those in group B ( 10 case vs 4 case;9 case vs 2 case).The incidence of restlessness in recovery period in group B was more than those in group A (9 case vs 3 case).The differences between two groups were significant ( P ＜ 0.05).Conclusions Compared with sevoflurane-sufentanyl combined anesthesia,TIVA with propofol can efficiently decrease intrapulmonary shunt fraction and improve arterial oxygenation during OLV for thoracoscope surgery,which is good for the prevention of hypoxemia.