七氟醚麻醉深度对单肺通气时肺顺应性的影响

目的 观测不同最低肺泡有效浓度(MAC)七氟醚对单肺通气(OLV)时肺顺应性的影响.方法 选择45例择期左开胸手术患者,ASA Ⅰ~Ⅱ级,随机分为七氟醚0.5 MAC组(Ⅰ组)1.0 MAC(Ⅱ组)和1.5 MAC(Ⅲ组)三组,每组15例.三组均用芬太尼2 μg/kg,依托米脂0.2 mg/kg和琥珀胆碱(司可林)1.5 mg/kg进行麻醉诱导,然后经口插入右双腔支气管导管控制呼吸,术中七氟醚分别以0.5 MAC、1.0 MAC和1.5 MAC,瑞芬太尼以0.5 μg/(kg·h),维库溴铵以0.05 mg/(kg·h)维持麻醉.在MAC值稳定后分别记录侧身双肺通气0、3 min单肺通气2、3、4、5、15 min的气道压、气道压峰值(Ppeak)、气道平台压(Pplat)、血氧饱和度(SaO2)、平均动脉压(MAP)、呼气末二氧化碳(PETCO2)和顺应性.结果 OLV后3组患者的顺应性明显降低(P<0.05),其他参数均无差异;OLV后Ⅲ组与其他两组之间差异有统计学意义(P<0.05).结论 1.5 MAC七氟醚在右侧单肺通气时对顺应性有明显增强效应,0.5 MAC和1.0 MAC 七氟醚影响轻微.

Subject effect of different concentrations of Sevoflurane on lung complince during one-lung ventilation

Objective To observe the＇alterations of lung compliance during different concentrations of sevoflurane anesthesia in patients undergoing thracic surgery. Methods Forty-five ASA Ⅰ-Ⅱ patients sched- uled for elective left-side thoracic surgery were divided into three groups randomly and equally. Anesthesia was induced with Fentanyl 2 μg/kg,Etomidate0. 2 mg/kg and succinglcholine 1.5 mg/kg. And double-lumen endotracheal tubes were intubated. Anesthesia was maintained with sevoflurane （MAC = 0. 5,1.0,1.5 respectively） inhalation and Remifentanil pumped in a dose of 2 μg/（ kg ·h）. and Vecuronium Bromide pumped in a dose of 0.05 μg/（kg · h）. After MAC stabilizing,plateau airway pressure,Ppeak ,Pplat,SaO2, MAP, HR, PETCO2 and lung compliance were measured 0,3 min after two-lung ventilation 2,3,4,5 and 15 rain after the right one-lung ventilation respectivelly. Results Lung compliance decreased significantly during OLV than TLV （ P 〈 0. 05）, there were no significant differences with respect to other indexes. No significant differece was found in lung-compliance among the three groups during TLV （ P 〉 0. 05 ）. The third group had significant difference than the other two groups undergoing OLV （P 〈 0.05 ）. Conclusion During the right OLV, Sevoflurane 1.5 MAC enhance significantly lung compulance, while sevoflurane 0. 5 MAC and 1.0 MAC affects it slightly.