国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
3期
213-216
,共4页
王伟芝%罗艳华%董桂敏%王绍明
王偉芝%囉豔華%董桂敏%王紹明
왕위지%라염화%동계민%왕소명
单肺通气%七氟醚%肺摄取%脑电双频指数%呼出气浓度
單肺通氣%七氟醚%肺攝取%腦電雙頻指數%呼齣氣濃度
단폐통기%칠불미%폐섭취%뇌전쌍빈지수%호출기농도
One-lung ventilation%Sevoflurane%Pulmonary uptake%Bispectral Index%Et
目的 观察吸入麻醉过程中单肺通气(one-lung ventilation,OLV)与双肺通气(two-lung ventilation,TLV)比较七氟醚的肺摄取情况. 方法 选择食道癌根治术患者15例(OLV组)和胃癌根治术患者15例(TLV组),分别于全麻诱导后插入双腔支气管导管或单腔气管导管控制呼吸,行七氟醚吸入麻醉,记录每组患者各个时点的脑电双频指数(bispectral index,BIS)、七氟醚吸入气浓度(Fi)和呼出气浓度(Et),并计算Et/Fi,进行组间及组内各时间点的比较. 结果 组间:OLV组BIS高于TLV组(P＜0.05);OLV组Et/Fi高于TLV组(P＜0.01).OLV组:BIS呈逐渐下降趋势,5min达到临床麻醉水平(60),5min～120 min维持在临床麻醉深度(40～60);Et呈逐渐上升趋势,2 min～30 min未进入稳态(P＜0.05),30 min达到稳态.Et/Fi呈逐渐升高趋势,2 min～50 min内未进入稳态(P＜0.05),50 min达到稳态(连续30 min)(P＞0.05),50 min～120 min变化无统计学意义(P＞0.05).TLV组:BIS呈逐渐下降趋势,2min达到临床麻醉水平(60),2 min～70 min维持在临床麻醉深度(40～60),70 min～120 min低于40;Et呈逐渐上升趋势,2 min～20 min未进入稳态(P＜0.05),20 min达到稳态(连续30 min)(P＞0.05).Et/Fi呈逐渐升高趋势,2 min达到稳态,2min～120 min变化无统计学意义(P＞0.05). 结论 OLV对七氟醚的肺摄取有一定影响.OLV摄取总量少于TLV,2min～50 min摄取速率高于TLV.OLV与TLV均可达到满足手术要求的麻醉深度,但TLV组在70 min后应适当调整吸入浓度以避免麻醉过深.与TLV比较,OLV麻醉深度较浅,达到稳定麻醉状态的时间较长.
目的 觀察吸入痳醉過程中單肺通氣(one-lung ventilation,OLV)與雙肺通氣(two-lung ventilation,TLV)比較七氟醚的肺攝取情況. 方法 選擇食道癌根治術患者15例(OLV組)和胃癌根治術患者15例(TLV組),分彆于全痳誘導後插入雙腔支氣管導管或單腔氣管導管控製呼吸,行七氟醚吸入痳醉,記錄每組患者各箇時點的腦電雙頻指數(bispectral index,BIS)、七氟醚吸入氣濃度(Fi)和呼齣氣濃度(Et),併計算Et/Fi,進行組間及組內各時間點的比較. 結果 組間:OLV組BIS高于TLV組(P＜0.05);OLV組Et/Fi高于TLV組(P＜0.01).OLV組:BIS呈逐漸下降趨勢,5min達到臨床痳醉水平(60),5min～120 min維持在臨床痳醉深度(40～60);Et呈逐漸上升趨勢,2 min～30 min未進入穩態(P＜0.05),30 min達到穩態.Et/Fi呈逐漸升高趨勢,2 min～50 min內未進入穩態(P＜0.05),50 min達到穩態(連續30 min)(P＞0.05),50 min～120 min變化無統計學意義(P＞0.05).TLV組:BIS呈逐漸下降趨勢,2min達到臨床痳醉水平(60),2 min～70 min維持在臨床痳醉深度(40～60),70 min～120 min低于40;Et呈逐漸上升趨勢,2 min～20 min未進入穩態(P＜0.05),20 min達到穩態(連續30 min)(P＞0.05).Et/Fi呈逐漸升高趨勢,2 min達到穩態,2min～120 min變化無統計學意義(P＞0.05). 結論 OLV對七氟醚的肺攝取有一定影響.OLV攝取總量少于TLV,2min～50 min攝取速率高于TLV.OLV與TLV均可達到滿足手術要求的痳醉深度,但TLV組在70 min後應適噹調整吸入濃度以避免痳醉過深.與TLV比較,OLV痳醉深度較淺,達到穩定痳醉狀態的時間較長.
목적 관찰흡입마취과정중단폐통기(one-lung ventilation,OLV)여쌍폐통기(two-lung ventilation,TLV)비교칠불미적폐섭취정황. 방법 선택식도암근치술환자15례(OLV조)화위암근치술환자15례(TLV조),분별우전마유도후삽입쌍강지기관도관혹단강기관도관공제호흡,행칠불미흡입마취,기록매조환자각개시점적뇌전쌍빈지수(bispectral index,BIS)、칠불미흡입기농도(Fi)화호출기농도(Et),병계산Et/Fi,진행조간급조내각시간점적비교. 결과 조간:OLV조BIS고우TLV조(P＜0.05);OLV조Et/Fi고우TLV조(P＜0.01).OLV조:BIS정축점하강추세,5min체도림상마취수평(60),5min～120 min유지재림상마취심도(40～60);Et정축점상승추세,2 min～30 min미진입은태(P＜0.05),30 min체도은태.Et/Fi정축점승고추세,2 min～50 min내미진입은태(P＜0.05),50 min체도은태(련속30 min)(P＞0.05),50 min～120 min변화무통계학의의(P＞0.05).TLV조:BIS정축점하강추세,2min체도림상마취수평(60),2 min～70 min유지재림상마취심도(40～60),70 min～120 min저우40;Et정축점상승추세,2 min～20 min미진입은태(P＜0.05),20 min체도은태(련속30 min)(P＞0.05).Et/Fi정축점승고추세,2 min체도은태,2min～120 min변화무통계학의의(P＞0.05). 결론 OLV대칠불미적폐섭취유일정영향.OLV섭취총량소우TLV,2min～50 min섭취속솔고우TLV.OLV여TLV균가체도만족수술요구적마취심도,단TLV조재70 min후응괄당조정흡입농도이피면마취과심.여TLV비교,OLV마취심도교천,체도은정마취상태적시간교장.
Objective To observe the effect of one-lung ventilation (OLV) or two-lung ventilation (TLV) on pulmonary uptake of sevoflurane.Methods Fifteen patients with esophageal tumorectomy and fifteen patients with stomach tumorectomy were selected for OLV and TLV during the operation,respectively.Sevoflurane was used for the general anesthesia.Bispectral index (BIS),Fi and Et were recorded at each measurement point,and Et/Fi was calculated.Results The BIS value of OLV group was higher than that of TLV group (P＜0.05),Et/Fi in OLV group was higher than TLV group (P＜0.01).OLV group:the BIS value gradually decreased and reached into an anesthetic state (BIS:60) at 5 min,and then enough anesthesia depth (BIS:40-60) was maintained during 5 min-120 min.Et gradually increased and reached into a steady state at 30 min.Et/Fi increased and reached into a steady state at 50 min,and the Et/Fi during 50 min-120 min had no statistical significance (P＞0.05).TLV group:the BIS value gradually decreased and reached into an anesthetic state at 2 min,and then enough anesthesia depth was maintained during 2 min-70 min.However,the BIS value was less than 40 after 70 min.Et gradually increased and reached into a steady state at 20 min.Et/Fi gradually increased and reached into a steady state at 2 min,and the Et/Fi during 2 min-120 min had no statistical significance (P＞0.05).Conclusions OLV had an effect on pulmonary uptake of sevoflurane.The total amount of sevoflurane uptake in OLV was less than that in TLV,while the uptake rate of OLV during 2 min-50 min was faster than that of TLV.Both OLV and TLV could supply a surgery-needed anesthetic depth with sevoflurane inhalant concentration 3％vol.However,inhalant concentration should be adjusted after 70 min to avoid excessive anesthesia during TLV.Furthermore,the anesthetic depth of OLV was less than that of TLV,and OLV needed a longer time to reach into a steady state compared with TLV.
