CAJ | 학술논문

目的：探讨参麦注射液对单肺通气（ OLV）术患者肺内分流及动脉氧合的影响。方法：择期行开胸手术单肺通气患者60例，美国麻醉医师协会（ ASA）分级和纽约心脏病协会（ NYHA）分级均为Ⅰ～Ⅱ级。采用随机数字表法，将患者随机分为参麦注射液组（SM组，n＝30）和生理盐水对照组（NS组，n＝30）。麻醉诱导后，SM组静脉滴注参麦注射液（0．6 ml／kg加至250 ml生理盐水）；在相同时间内NS组给予等量生理盐水，于单肺通气前滴注完毕。连续观察心率（ HR）、平均动脉血压（ MAP）、气道压力（ Paw）及血流动力学指标，分别于麻醉诱导前（ T0）、单肺通气前（ T1）、单肺通气10分钟（ T2）、30分钟（ T3）、60分钟（ T4）、120分钟（ T5）、单肺通气结束后10分钟（ T6）和手术结束（ T7）时行动脉血气和混合静脉血气分析，计算肺内分流量（ QS／QT ）、肺泡～动脉血氧分压差P（A～a）DO2及呼吸指数（RI）。结果：SM组患者T2～T5时的动脉血PaO2明显高于NS组（P＜0．01），而QS／QT则显著低于NS组（P＜0．01）。 SM组患者T2～T5时的P（A～a）DO2及RI均明显低于NS组（P＜0．01）。结论：参麦注射液用于单肺通气术患者，能有效改善动脉氧合及减少肺内分流，从而对胸科手术患者产生一定的肺保护作用。
목적：탐토삼맥주사액대단폐통기（ OLV）술환자폐내분류급동맥양합적영향。방법：택기행개흉수술단폐통기환자60례，미국마취의사협회（ ASA）분급화뉴약심장병협회（ NYHA）분급균위Ⅰ～Ⅱ급。채용수궤수자표법，장환자수궤분위삼맥주사액조（SM조，n＝30）화생리염수대조조（NS조，n＝30）。마취유도후，SM조정맥적주삼맥주사액（0．6 ml／kg가지250 ml생리염수）；재상동시간내NS조급여등량생리염수，우단폐통기전적주완필。련속관찰심솔（ HR）、평균동맥혈압（ MAP）、기도압력（ Paw）급혈류동역학지표，분별우마취유도전（ T0）、단폐통기전（ T1）、단폐통기10분종（ T2）、30분종（ T3）、60분종（ T4）、120분종（ T5）、단폐통기결속후10분종（ T6）화수술결속（ T7）시행동맥혈기화혼합정맥혈기분석，계산폐내분류량（ QS／QT ）、폐포～동맥혈양분압차P（A～a）DO2급호흡지수（RI）。결과：SM조환자T2～T5시적동맥혈PaO2명현고우NS조（P＜0．01），이QS／QT칙현저저우NS조（P＜0．01）。 SM조환자T2～T5시적P（A～a）DO2급RI균명현저우NS조（P＜0．01）。결론：삼맥주사액용우단폐통기술환자，능유효개선동맥양합급감소폐내분류，종이대흉과수술환자산생일정적폐보호작용。
Objective:To investigate the effects of Shenmai Injection on arterial oxygenation and pulmonary shunt during one -lung ventilation (OLV) in thoracic surgery patients.Methods:Sixty American Society of Anesthesiologists (ASA)Ⅰ-Ⅱand New York Heart Association ( NYHA)Ⅰ-Ⅱpatients undergoing OLV during elective thoracic surgery were randomly allocated into two groups ( n=30 ):Shenmai Injection group ( SM group) and normal saline control group ( NS group) .The anesthetics of induction were the same in the two groups.After induction, the patients of SM group were received intravenously Shenmai Injection (0.6 ml/kg added to 250 ml normal sa-line) , and the patients of NS group were given intravenously with equivalent normal saline at the same time , both completed before OLV . Time of liquid infusion, duration of OLV, time of anesthetic maintenance and hemodynamics were recorded .Heart rate (HR), mean arte-rial pressure (MAP), airway pressure (Paw) and hemodynamics indexes were continuously recorded .Arterial blood gas and mixed ve-nous blood gas were tested respectively before anesthesia induction ( T0 ) , before OLV ( T1 ) , 10 min ( T2 ) , 30 min ( T3 ) , 60 min (T4), 120 min (T5) after OLV, 10 min after OLV over (T6) and the end of surgery (T7), and QS/QT, alveolar-arterial differences for O2 partial pressure ( P( A-a) DO2) and respiratory index ( RI) of each group at the above -mentioned time points were calculated . Results:There was no statistical significance in time of liquid infusion , duration of OLV, time of anesthetic maintenance , and hemody-namics indexes (P>0.05) between the two of groups.Compared to NS group, PaO2 in SM group from T2 to T5 were higher (P<0.01), and QS/QT of SM group in the same period of time were lower (P<0.01).Compared to NS group, P(A-a)DO2 and RI in SM group from T2 to T5 were both lower (P<0.01).There was no statistically significant difference between SM group and NS group in MAP、HR and Paw (P>0.05).Conclusion:Intravenous administration of Shenmai Injection before OLV could effectively improve arterial oxygena -tion and decrease intrapulmonary shunt .