5％碳酸氢钠对单肺通气患者血气的影响

目的评价5％碳酸氢钠（NaHCO3）对开胸单肺通气（OLV）患者术中血气的影响。方法择期开胸手术患者60例。男44例，女16例。年龄18～65岁。体重55～80kg。随机等分3组。I组：空白对照；II组：5％NaHC0330mL；III组：5％NaHCO360mL。连续监测血压（BP）、心率（I-IR）、动脉氧饱和度（SpO2）等。3组均采用静吸复合麻醉，诱导静注芬太尼3μg/kg、丙泊酚1．5～2．0mg／kg、琥珀胆碱1．5mg／kg，维持吸入1．0％-2．0％异氟烷，持续输注瑞芬太尼0．1～0．2μg／（kg·min）和间断静注维库溴铵0．02～0．03mg／kg。OLV后应用5％NaHCO3（Ⅱ组：1mL/min；Ⅲ组：2mL/min），分别在麻醉前（T0）、麻醉诱导后双肺通气时（T1）、单肺通气30分钟时（T2）、手术完毕前双肺通气时（L）采外周动脉血1mL进行血气分析。结果麻醉后组内比较：SpO2、动脉氧分压（PaO2）、血氧饱和度（SaO2）和CL^-3组麻醉后均有升高，与T0比较（P〈0．05或P〈0．01）；pH值、碱剩余（BE）和K‘3组在麻醉后均有下降，与T0比较（P〈0．05或P〈0．01）。麻醉后同时间段组间比较：SaO2在T2时间段Ⅲ组比I组和Ⅱ组高（P〈0．05）；BE在T2时间段、T3时间段Ⅲ组比I组高（P〈0．05和P〈0．01）。Ⅲ组患者苏醒最快，与I组比较（P〈0．05）。结论Ⅲ组患者呼吸系统相对平稳，保持较高的SaO2，pH值和BE值下降幅度减小，苏醒迅速，有高氯代酸倾向，但是不会影响CO2的排除。

The effects of 5% sodium bicarbonate injection on blood gas of patients undergoing one-lung ventilation

Objective To evaluate the effects of 5 % NaHCO3 injection on arterial blood gas of the patients undergoing one-lung ventilation. Methods Sixty patients （44 male and 16 female） , having scheduled for thoracic surgery, age 18 - 65 yr, weight 55-80 kg, were randomly divided into three groups（n =20 respectively）, contrast group （group I ） and experiment groups（group II and group III ）. In group 11 ： 5 % NaHCO3 injection 30mL. In group III ： 5 % NaHCO3 injection 60mL. The patients were continuously monitored BP, HR, SpO2, et aL Three groups were used the same general anesthesia. All patients were induced with fentanyl 3 μg/kg, propofol 1.5 - 2 mg/kg and suceinylcholine 1.5 mg/kg iv and maintained with inhalated isoflurane （1% -2 % ）, continuously infused remifentanil 0. 1 -0. 2 μg/（kg· min） and intermittent veeurenium 0. 02 -0. 03 mg/kg iv. During OLV, continuously infused 5 % NaHCO3 injection （ group II ： 1mL/min and group III ： 2mL/min）. 1 mL blood samples were taken from the radial artery before anesthesia （ T0 ）, before of OLV （ T1 ）, 30 min after OLV （ T2 ）, before the end of the operation （ T3 ） for determination. Results Comparing in the same group： SpO2, PaO2, SaO2, and CL-were increased, while pH, BE and K^＋ were decreased after anesthesia as compared with the base line values in the same group （ P 〈 0. 05 or P 〈 0.01 ）. Comparing among the groups ： SaO2 （ T2 ） were higher in group III than those in group I and in group II （ P 〈 0. 05 ） , while BE （ T2, T3 ） were higher in group III than those in group I （ P 〈 0. 05 or P 〈 0. 01 ）. Comparing with in group I, the patients in group m recovered rapidly （ P 〈 0. 05）. Conclusion The patients were used 5 % NaHCO3 injection in group III. It can keep respiration stability, increase SaO2, reduce the change of pH and BE, recovered rapidly, there was the inclination of hyperehloremia and metabolic acidosis. But it can＇ t increase PaCOz of the patients during OLV.