5％碳酸氢钠用于单肺通气的临床研究

目的研究5％碳酸氢钠（NaCO3）注射液对OLV患者血液酸碱平衡和肺内分流（Qs／Qt）的影响。方法择期ASAⅠ或Ⅱ级20～60岁行开胸手术60例，随机等分3组。实验l组：空白对照；实验Ⅱ组：5％NanC03注射液30ml；实验Ⅲ组：5％NanC03注射液60ml。三组均采用静吸复合麻醉，诱导：静脉注射芬太尼3to／ks、丙t自酚1．5～2mg／ks、琥珀胆碱1．5mg／kg，维持：吸入1～2％异氟烷、连续输注瑞芬太尼0．1～0．25旭／（ks·min）、间断应用维库溴铵0．02～0．03ms／ks。连续监测BP、HR、S002和PETC02。在麻醉前基础值（T0）、麻醉诱导后双肺通气时（T1）、单肺通气30min时（T2）、手术完毕前双肺通气时（T3）采外周动脉血1ml进行血气分析并计算Qs／Qt。结果三组患者的BP、HR、SpO2、PETC02和PaC02等组间比较差异无统计学意义（P〉0．05）。oH值、PaO2、BE值、Qs／Qt实验组与对照组组间比较差异有统计学意义（P〈0．01和P〈0．05）。结论5％NaHCO3注射液能使OLV下开胸手术患者血液pH值下降减小，使氧离曲线右移减少。手术中患者pH值接近中性或手术前状态，有利于肺血管发挥正常的生理功能、促进HPV（缺氧性肺血管收缩）反应、降低Qs／Qt，而不会影响CO2排除的程度。

Use of 5% sodium bicarbonate injection in patients undergoing one-lung ventilation

Objective To study the effects of 5 % sodium bicarbonate injection on acidbase balance and pulmonary shunt （Qs/Qt） of the patients undergoing one - lung ventilation. Methods Sixty ASA gradesⅠ or Ⅱ patients for elective thoracotomy, aged 20～ 60 yr, were randomly divided into three equal groups. Contrast group （group Ⅰ ）,Experimental group Ⅱ（5% NaHCO3 30 ml） and Experimental group Ⅲ（5% NaHCO3 60 ml）.In all groups,anesthesia was induced with fentanyl 3 pg/kg, propofol 1.5 - 2 mg/kg and suecinyleholine 1.5 mg/kg iv, and maintained with inhaled isoflurane （ 1%～ 2% ）, infused remifentanil 0.1 - 0.2 μg/（ kg·min） continuously and vecuronium 0.02 0.03 mg/kg iv intermittently. BP, FIR, SpO2, and PETC02 were monitored continuously. Blood samples were taken from the radial artery before anesthesia（T0）, after induction（during two - lung ventilation T1 ）, at 30 min after one - hmg ventilation（T2） and before the end of operation （TLV, T3 ） for measurement of blood gases and calculation of Qs/Qt. Results In the three groups, there were no statistical differences in BP, HR,SpO2,PEq＇CO2 and PaCOz（ P 〉 0.05）. pH, PaO2,BE, and Qs/Qt in patients of Experimental groups were significantly different from those in contrast group（ P 〈 0.05 or P 〈 0.01 ）. Conclusions 5 % sodium bicarbonate injection decreases the fall of pH and the movement of oxyhemoglobin dissociation curve to right, pH is close to 7.40 or the condition before operation. As the result, it will do good to the mainraining of pulmonary vascular function, promotion of HPV and decrease of Qs/Qt. However, it does not affect the degree of CO2 exclusion.