CAJ | 학술논문

目的：探讨七氟烷预处理或后处理对胸科手术单肺通气（OLV）患者肺内分流的影响。方法80例择期行开胸手术OLV的患者分为4组：全凭静脉组（P组），七氟烷预处理组（S1组），七氟烷后处理组（S2组），七氟烷全程吸入组（S3组），每组20例。在麻醉诱导前（T0）、OLV前（T1）即七氟烷预处理30 min后、OLV 30 min（T2）、OLV 60 min（T3）、OLV结束前（T4）、OLV结束后30 min（T5）采集桡动脉及右心房血样行血气分析，计算肺内分流率（Qs/Qt），同时记录血流动力学指标及相关的临床数据。结果 OLV期间，4组患者氧分压较双肺通气时明显降低（P＜0．05），但4组间的氧分压比较差异无统计学意义（P＞0．05）；4组患者的肺内分流较双肺通气时明显增加（ P＜0．05），但S1、S2、S3组的肺内分流较P组低（ P＜0．05），S1、S2、S3组间差异无统计学意义（P＞0．05）。结论七氟烷预处理、后处理全程处理能降低OLV患者肺内分流，但3种处理方式之间无显著差异，也不能明显提高动脉氧分压。
목적：탐토칠불완예처리혹후처리대흉과수술단폐통기（OLV）환자폐내분류적영향。방법80례택기행개흉수술OLV적환자분위4조：전빙정맥조（P조），칠불완예처리조（S1조），칠불완후처리조（S2조），칠불완전정흡입조（S3조），매조20례。재마취유도전（T0）、OLV전（T1）즉칠불완예처리30 min후、OLV 30 min（T2）、OLV 60 min（T3）、OLV결속전（T4）、OLV결속후30 min（T5）채집뇨동맥급우심방혈양행혈기분석，계산폐내분류솔（Qs/Qt），동시기록혈류동역학지표급상관적림상수거。결과 OLV기간，4조환자양분압교쌍폐통기시명현강저（P＜0．05），단4조간적양분압비교차이무통계학의의（P＞0．05）；4조환자적폐내분류교쌍폐통기시명현증가（ P＜0．05），단S1、S2、S3조적폐내분류교P조저（ P＜0．05），S1、S2、S3조간차이무통계학의의（P＞0．05）。결론칠불완예처리、후처리전정처리능강저OLV환자폐내분류，단3충처리방식지간무현저차이，야불능명현제고동맥양분압。
Objective To study the effect of sevoflurane pretreatment or aftertreatment on intrapulmonary shunt for patients with one lung ventilation(OLV)during thoracic surgical procedures .Methods 80 ASA I or II patients underwent thoracic surgery with OLV were randomly divided into four groups(n= 20 for each):(1)Propofol group(group P);(2)Sevoflurane pretreatment group(group S1);(3)Sevoflurane aftertreatment group(group S2);(3)Sevoflurane whole-treatment group(group S3) .Blood sam-ples were taken from radial artery and right atrial blood before induction of anesthesia(baseline T .0) ,before OLV(sevoflurane pre-treatment 30 min ,T1) ,after OLV 30 ,60 min and before the end of OLV(T2-T4)and after the end of OLV(T5)for measurement of blood gases and calculation of Qs/Qt .The indexs of hemodynamics and relative clinical data were recorded .Results Arterial oxy-gen pressure of the four groups for OLV significantly reduced ,when compared with double lung ventilation(P<0 .05) ,but there was no significant difference among the four groups(P>0 .05) .Intrapulmonary shunt of the four groups for OLV significantly in-creased ,when compared with double lung ventilation(P<0 .05) ,but intrapulmonary shunt of S1 ,S2 and S3 groups significantly de-creased ,when compared with P group ,and there was no significant difference for S1 ,S2 and S3 groups(P> 0 .05) .Conclusion Sevoflurane can decrease intrapulmonary shunt for patients during OLV ,but there is no significant difference for pretreatment or af-tertreatment or whole treatment and do not increase arterial oxygen pressure .