临床医学
臨床醫學
림상의학
CLINICAL MEDICINE
2010年
8期
32-34
,共3页
单肺通气%七氟醚%异丙酚%肺内分流率%血气
單肺通氣%七氟醚%異丙酚%肺內分流率%血氣
단폐통기%칠불미%이병분%폐내분류솔%혈기
One-lung ventilation%Sevoflurane%Propofol%Intrapulmonary shunt%Blood gas
目的 观察七氟醚复合异丙酚麻醉在胸外科手术行单肺通气期间对肺内分流和血气的影响.方法 30例ASAⅠ～Ⅱ级的患者,用芬太尼4～5 μg/kg,咪唑安定0.05 mg/kg,异丙酚1.5～2 mg/kg,维库溴铵0.1 mg/kg作静脉快速诱导,插入双腔气管导管.用丙泊酚每千克体重6～8 mg/h泵注,吸入1.3～2.5 MAC的七氟醚,间断静脉滴注维库溴铵和芬太尼维持麻醉.分别在单肺通气前1 min(T1)、单肺通气15 min(T2)、30 min(T3)及单肺通气结束前1 min(T4)各时刻抽取动脉血和混合静脉血行血气分析,并根据血气分析结果计算肺内分流率(Qs/Qt).结果 T2、T3、T4时刻,肺内分流率较T1时刻显著增加,动脉血氧分压较T1时刻显著下降, T4时刻的动脉血氧分压较T3时刻有所回升.结论 单肺通气时七氟醚复合异丙酚静吸麻醉虽然对肺内分流有影响,但不影响其在临床中安全应用.
目的 觀察七氟醚複閤異丙酚痳醉在胸外科手術行單肺通氣期間對肺內分流和血氣的影響.方法 30例ASAⅠ～Ⅱ級的患者,用芬太尼4～5 μg/kg,咪唑安定0.05 mg/kg,異丙酚1.5～2 mg/kg,維庫溴銨0.1 mg/kg作靜脈快速誘導,插入雙腔氣管導管.用丙泊酚每韆剋體重6～8 mg/h泵註,吸入1.3～2.5 MAC的七氟醚,間斷靜脈滴註維庫溴銨和芬太尼維持痳醉.分彆在單肺通氣前1 min(T1)、單肺通氣15 min(T2)、30 min(T3)及單肺通氣結束前1 min(T4)各時刻抽取動脈血和混閤靜脈血行血氣分析,併根據血氣分析結果計算肺內分流率(Qs/Qt).結果 T2、T3、T4時刻,肺內分流率較T1時刻顯著增加,動脈血氧分壓較T1時刻顯著下降, T4時刻的動脈血氧分壓較T3時刻有所迴升.結論 單肺通氣時七氟醚複閤異丙酚靜吸痳醉雖然對肺內分流有影響,但不影響其在臨床中安全應用.
목적 관찰칠불미복합이병분마취재흉외과수술행단폐통기기간대폐내분류화혈기적영향.방법 30례ASAⅠ～Ⅱ급적환자,용분태니4～5 μg/kg,미서안정0.05 mg/kg,이병분1.5～2 mg/kg,유고추안0.1 mg/kg작정맥쾌속유도,삽입쌍강기관도관.용병박분매천극체중6～8 mg/h빙주,흡입1.3～2.5 MAC적칠불미,간단정맥적주유고추안화분태니유지마취.분별재단폐통기전1 min(T1)、단폐통기15 min(T2)、30 min(T3)급단폐통기결속전1 min(T4)각시각추취동맥혈화혼합정맥혈행혈기분석,병근거혈기분석결과계산폐내분류솔(Qs/Qt).결과 T2、T3、T4시각,폐내분류솔교T1시각현저증가,동맥혈양분압교T1시각현저하강, T4시각적동맥혈양분압교T3시각유소회승.결론 단폐통기시칠불미복합이병분정흡마취수연대폐내분류유영향,단불영향기재림상중안전응용.
Objective To evaluate the effects of sevoflurane combined with propofol for one lung ventilation(OLV) on intrapulmonary shunt(Qs/Qt) and blood gas. Methods Thirty ASAⅠ-Ⅱpatients were selected in the study. Anesthesia was induced with midazolam 0.05 mg/kg,fentanyl 4-5 μg/kg,propofol(1.5-2)mg/kg,and vecuronium 0.1 mg/kg,and double-lumen endotracheal tubes were intubated.Anesthesia was maintained with 1.3-2.5 MAC sevoflurane inhalation, propofol 6-8 mg/h and intermittent iv boluses of vecuronium and fentanyl arterial blood and mixed venous blood were taken for blood gas analysis 1 minute before OLV(T1),15 minutes after OLV(T2), 30 minutes after OLV(T3),and 1 minute before OLV(T3) was over. Qs/Qt was calculated.Results Intrapulmonary shunt (Qs/Qt) increased significantly and PaO2 decreased significantly at T2, T3and T4 compared with those at T1(P<0.01),and PaO2 increased significantly at T4 compared with those at T3(P<0.05).Conclusion During the OLV sevoflurane inhalation combined with propofol has influences on intrapulmonary shunt, but can be safely used clinically.
