CAJ | 학술논문

目的：探讨食管癌手术采取全麻复合硬膜外阻滞麻醉时对单肺通气（ OLV）期间动脉氧合的影响。方法选择60例行经左胸食管癌根治术患者（ ASAIII级），随机分为静脉全麻复合硬膜外阻滞麻醉组（ A组，30例）和仅静脉全麻组（ B组，30例）。两组患者分别于OLV前（ T1）、OLV 15min（ T2）、OLV 30min（ T3）抽取桡动脉血和混合静脉血行血气分析，计算通气/血流比（Qs/Qt）值。结果在T2和T3时，A组氧分压（PaO2）分别为（219?3±48?2）mmHg和（174?7±37?6）mmHg，显著低于B组的（268?1±81?2）mmHg和（221?6±87?0）mmHg。在OLV期间，A组的Qs/Qt显著高于B组（P＜0?05），各时间点A组血压均显著低于B组（ P＜0?05）。结论全麻复合硬膜外阻滞麻醉时会引起食管癌患者术中血压下降，而且会引起OLV期间肺内分流的增加和氧分压的降低。
목적：탐토식관암수술채취전마복합경막외조체마취시대단폐통기（ OLV）기간동맥양합적영향。방법선택60례행경좌흉식관암근치술환자（ ASAIII급），수궤분위정맥전마복합경막외조체마취조（ A조，30례）화부정맥전마조（ B조，30례）。량조환자분별우OLV전（ T1）、OLV 15min（ T2）、OLV 30min（ T3）추취뇨동맥혈화혼합정맥혈행혈기분석，계산통기/혈류비（Qs/Qt）치。결과재T2화T3시，A조양분압（PaO2）분별위（219?3±48?2）mmHg화（174?7±37?6）mmHg，현저저우B조적（268?1±81?2）mmHg화（221?6±87?0）mmHg。재OLV기간，A조적Qs/Qt현저고우B조（P＜0?05），각시간점A조혈압균현저저우B조（ P＜0?05）。결론전마복합경막외조체마취시회인기식관암환자술중혈압하강，이차회인기OLV기간폐내분류적증가화양분압적강저。
Objective To study the effects of thoracic epidural anesthesia(TEA) with bupivacaine on oxygenation, shunt fraction during one-lung ventilation( OLV) . Methods Sixty patients who had prolonged periods of OLV for elective thoracic surgery for esophageal cancer were randomized into two groups. Thirty patients ( group A) were anesthetized with propofol/atracurium/epidural thoracic bupivacaine 0?5%. In another 30 patients ( group B) , fentanyl/propofol/atracurium anesthesia was used. A double-lumen en-dotracheal tube was inserted, and mechanical ventilation with 100% oxygen was used during the entire study. Arterial and venous blood gases were recorded before surgery in a lateral position with two-lung ventilation, 15 and 30 min after OLV ( OLV+15 and OLV+30, respectively) in all patients. PaO2, venous central oxygen tension, arterial and central venous oxygen saturation, venous admixture per-centage (Qs/Qt) were measured. Results The mean values for PaO2 during OLV in the group A after 15min with (219?3±48?2)mm-Hg and 30min with ( 174?7 ± 37?6 ) mmHg were significantly lower compared with the group B ( 268?1 ± 81?2mmHg and 221?6 ± 87?0mmHg, respectively) . Furthermore, Qs/Qt was significantly increased in group A during OLV. And, blood pressure was signifi-cantly lower in group A during surgery. There were no significant differences. Conclusion We conclude that using the TEA regimen is associated with a lower PaO2 and a larger intrapulmonary shunt during OLV than with total anesthesia alone.