地氟醚与丙泊酚的不同配伍对单肺通气时肺内分流的影响

目的探讨地氟醚与丙泊酚的不同配伍在食管癌根治术单肺通气(One lung ventilation,OLV)期间对肺内分流的影响。方法选择择期行食管癌左侧开胸切除术患者45例,ASAⅠ～Ⅱ级,随机均分为3组(每组15例):丙泊酚组(P组)、地氟醚-丙泊酚组(DP组)和地氟醚组(D组),分别于平卧位双肺通气15min(T0),右侧卧位双肺通气15 min(T1),单肺通气15 min(T2)、30 min(T3)、60 min(T4)、90 min(T5)进行动脉血及混合静脉血血气分析,计算肺内分流率(Qs/Qt)。结果 TLV(T0)时,Qs/Qt组间比较,差异无统计学意义(P>0.05);OLV期间(T2～T5)Qs/Qt与TLV(T0)时相比,有明显增高(P<0.05),且D组明显高于P组和DP组(P<0.05),P组与DP组相比,差异无统计学意义(P>0.05)。三组OLV各时的PaO2较TLV时下降(P<0.05),但仍在安全范围内。结论临床剂量[3 mg/(kg.h)]丙泊酚复合低浓度地氟醚(<0.83MAC)对OLV的患者更安全有效。

Effect of desflurane and propofol with different compatibility on intrapulmonary shunt during one-lung ventilation

Objective To discuss the influence of desflurane and propofol with different compatibility on intrapulmonary shunt at one-lung ventilation in patients during radical surgery of esophageal cancer. Methods Forty-five ASA Ⅰ or Ⅱ undering radical surgery of esophageal cancer via left-side thoracic were divided into three groups randomly and equally(n=15):Propofol group(P),Desflurane-Propofol group(DP)and Desflurane group(D).After MAC stabilizing blood samples were taken from the right internal jugular central venous and dorsalis pedis artery at 15 min after bilateral ventilation(supine position)(T0),at 15min after bilateral ventilation(the right decubitus)(T1),at 15,30,60,90 min of OLV(T2～T5)for measurement of blood and calculation of Qs/Qt. Results There was no significant difference in Qs/Qt between 3 groups during TLV(P>0.05).During T1～T5,Qs/Qt increased more significantly than those of T0(P<0.05),and the increase of group D was more than that of group P and group DP(P<0.05),but there was no significant difference between group P and group DP(P>0.05). Conclusion Clinical dose[3 mg/(kg·h)]propofol and low concentrations of desflurane(<0.83MAC)is safe and effective during OLV.