七氟醚预处理对单肺通气时肺顺应性和氧合指数的影响被引量：22

Effect of sevoflurane preconditioning on lung compliance and oxygenation index during one lung ventilation

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摘要目的探讨七氟醚预处理对单肺通气（OLV）患者肺顺应性和氧合指数的影响。方法选择拟行肺叶切除术的肺癌患者60例,美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级,随机均分为七氟醚预处理组（n=30）、全凭静脉组（n=30）。两组患者采用相同全麻诱导后,行机械通气。七氟醚预处理组手术开始OLV前吸入1个肺泡最小有效浓度（1MAC）七氟醚30min,全凭静脉组采用丙泊酚维持麻醉。两组患者分别于麻醉前（T0）、侧卧位双肺通气30min（T1）、OLV30min（T2）、OLV60min（T3）、恢复双肺通气20min（T4）记录血流动力学指标、脉搏氧饱和度（SpO2）、气道平台压（Pplat）、计算动态气道顺应性（Cdyn）,T1~T4时采集桡动脉血测动脉血CO2分压（PaCO2）、动脉血氧分压（PaO2）和pH,计算氧合指数（动脉血氧分压/吸入氧浓度,PaO2/FiO2）。结果与T1时比较,两组T2、T3时PaO2/FiO2和Cdyn均明显下降（P〈0.05）。与全凭静脉组比较,T2、T3时七氟醚预处理组Cdyn明显升高（P〈0.05）。两组间各时间点PaO2/FiO2差异无统计学意义。结论与丙泊酚全凭静脉麻醉相比,七氟醚预处理可增加肺癌患者OLV时肺顺应性,对OLV时氧合指数的影响和丙泊酚没有差别。 Objective To investigate the effect of sevoflurane preconditioning on lung compliance and oxygenation index during one lung ventilation（OLV）. Methods In this study, sixty patients, ASA I or Ⅱ, scheduled for pul- monary surgeries were enrolled, and randomly divided into two groups： sevoflurane preconditioning group （n = 30） and total intravenous group（ n = 30 ）. For preconditioning, patients in sevoflurane preconditioning group were ad- ministrated with one minimal alveolar concentration（1MAC） sevoflurane for 30 min after general anesthesia induc- tion and then followed with total intravenous anesthesia. While in total intravenous group, only intravenous anes- thetic agents were administrated for maintenane of anesthesia after induction. The indexes of hemodynamics, pulse oximeter（ SpO2 ）, plateau pressure（Pplat） and lung compliance （Cdyn） were recorded at the following time points： before anesthesia（ To ） , after anesthesia induction at laternal position TLV 30 min（ T1 ） ,30 min after OLV（T2 ） , 60 min after OLV （ T3 ） and recovering TLV 20 min （ T4 ）. Arterial blood samples were taken to measure partial pressure of carbon dioxide（ PaCO2 ）, partial pressure of oxygen（ PaO2 ）, pH, oxygenation index（ PaO2/FiO2 ） at the follow- ing time points： T1 , T2, T3 , T4. Results Compared with T1 , the oxygenation index and lung compliance de- creased significantly at Z2, T3 （ P 〈 0. 05 ） ; compared with total intravenous group, the lung compliance was obvi- ously higher than that in sevoflurane preconditioning group at T2, T3 （ P 〈 0. 05 ）. There were no significantly differ- ences in the oxygenation index between total intravenous group and sevoflurane preconditioning group at all time points. Conclusion Compared with total intravenous anesthesia with propofol , sevoflurane preconditioning can im- prove lung compliance, but does not make contribute to improve oxygenation index.

作者陶洪霞沈启英李元海

机构地区安徽医科大学第一附属医院麻醉科

出处《安徽医科大学学报》 CAS 北大核心 2016年第5期682-685,共4页 Acta Universitatis Medicinalis Anhui

基金安徽省科技攻关计划项目(编号:1301042204)

关键词七氟醚单肺通气氧合指数肺顺应性 sevoflurane oneventilation lung compliance oxygenation index

分类号 R614 [医药卫生—麻醉学] R614.2 [医药卫生—麻醉学]

作者简介陶洪霞，女，硕士研究生；李元海，男，教授，主任医师，博士生导师，责任作者，E-mail：Liyuanhail@126．com

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