全麻气管插管后七氟醚和异氟醚吸入对吸烟患者呼吸力学的影响

目的 比较观察全麻气管插管后七氟醚和异氟醚吸入对吸烟和非吸烟患者气道阻力、肺顺应性和气道峰压的影响.方法 选择既往有和无吸烟史择期手术的普通外科患者80例美国麻醉医师协会(ASA)Ⅰ～Ⅱ级,既往有或无吸烟史患者各40例],随机分为4组(n=20):有吸烟史患者吸入七氟醚全麻组(SS组)和吸入异氟醚全麻组(SI组),无吸烟史患者吸入七氟醚全麻组(NS组)和吸入异氟醚全麻组(NI组).使用多功能麻醉气体监护仪监测患者吸入麻醉剂浓度达到肺泡最低有效浓度(1MAC)后4、8、12、16min的气道峰压、肺顺应性,同时用无创心功能测定仪监测气道阻力,记录各组患者在吸入麻醉剂期间各项指标的变化情况.结果 与吸入前相比,所有接受全麻气管插管的患者在使用七氟醚和异氟醚吸入维持4、8、12、16 min后均出现气道阻力和气道峰压的明显下降(均P＜0.05),其中SS组和NS组8min后下降趋于稳定气道阻力:SS组(10.38±1.12)cmH2O·L-1·s-1,NS组(9.65±1.04)cm H2O·L-1·s-1;气道峰压:SS组(13.52±1.01)cm H2O,NS组(12.86±0.94)cm H2O,1 cm H2O=0.098kPa],SI组和NI组则于12 min后下降趋于稳定气道阻力:SI组(10.30±0.98)cm H2O·L-1·s-1,NI组(11.00±0.73)cm H2O·L-1·s-1;气道峰压:SI组(13.47±0.88)cm H2O,NI组(12.85±0.65)cm H2O],同时间点的非吸烟组下降幅度高于吸烟组(均P＜0.05).4组患者在使用七氟醚和异氟醚吸入维持后其肺顺应性较吸入前均无明显变化(均P＞0.05),同时间点的非吸烟组与吸烟组相比肺顺应性差异也没有统计学意义(均P＞0.05).结论 全麻气管插管后七氟醚和异氟醚吸入使患者的气道阻力和气道峰压出现明显下降,吸烟者比非吸烟者下降程度低.

Effects of sevoflurane and isoflurane inhalation on respiratory mechanics in smoking patients after tracheal intubation in general anesthesia

Objective To investigate the effects of sevoflurane and isoflurane inhalation on airwayresistance, pulmonary compliance, and airway peak pressure in smoking versus nonsmoking patients early after tracheal intubation in general anaesthesia. Methods Eighty patients, with (n=40) or without (n=40)smoking history (ASA Ⅰ～Ⅱ ), scheduled for surgery under general anesthesia were randomly divided into four groups (n=20 each). Patients with smoking history were randomly divided into sevoflurane group (SS)and isoflurane group (SI), and those without smoking history into sevoflurane group (NS) and isoflurane group (NI). Datex-Ultima anaesthetic agent monitor was used to monitor lung compliance and airway peak pressure of patients at 4, 8, 12, 16 mins after minimal alveolar concentration (1 MAC) of inhalation anesthetics was reached. Meanwhile, non-invasive hemodynamic monitoring was used to monitor airway resistance, recorded and compared the changes in each of these indicators in the 4 groups after anesthetics inhalation. Results After tracheal intubation in general anesthesia and maintenance on inhaled sevoflurane and isoflurane for 4, 8, 12 and 16 mins, all the patients showed a significant decline in airway resistance and airway peak pressure (all P＜0.05) compared with before inhalation. Of all the groups, the declines tended to become stable after 8 mins in groups SS and NS airway resistance: (10.38±1.12) cm H2O·L-1·s-1 in SS group and (9.65±1.04) cm H2O·L-1·s-1 in NS group; airway peak pressure: (13.52±1.01) cm H2O in SS group and (12.86±0.94) cm H2O in NS group; 1 cm H2O=0.098 kPa], and after 12 mins in the groups SI NI group; airway peak pressure:(13.47±0.88) cm H2O in SI group and (12.85±0.65) cm H2O in NI group].Moreover, the declines were much greater in nonsmokers than those in smokers (all P＜0.05). The pulmonary compliance showed no significant change compared with before inhalation after the maintenance inhalation of sevoflurane and isoflurane among the 4 groups (all P＞0.05), nor any difference between non-smoking and smoking group at given time spots (all P＞0.05). Conclusion Sevoflurane and isoflurane exposure significantly decrease the airway resistance and airway peak pressure in all the patients after tracheal intubation under general anesthesia. The decline is much greater in nonsmokers as compared to smokers.