七氟烷对老年患者食管癌切除术肺功能和血乳酸的影响

目的观察七氟烷在胸腹腔镜下老年患者食管癌切除术中对肺功能和血乳酸的影响。方法选择食管癌根治术老年患者40例,年龄65～79岁,ASAⅠ～Ⅲ级,随机分为七氟烷组(S组,n=20例)和异丙酚组(P组,n=20例)。S组麻醉采用6%七氟烷吸入诱导,术中用1%～3%的七氟烷吸入维持麻醉深度。P组采用异丙酚效应室靶控输注麻醉,术中根据麻醉深度调整异丙酚用量。分别于单肺通气(OLV)即刻(T0)、OLV 90 min(T1)、单肺通气结束(T2)、进腹(T3)、关腹(T4)时点取桡动脉血和混合静脉血行血气分析,计算肺泡-动脉氧分压差(PA-OO2)、呼吸指数(RI)和肺内分流率(Qs/Qt)、肺动态顺应性(Cd)、混合静脉血乳酸的含量。结果与T0时比较,两组T1～T3时点PA-aO2、RI和Qs/Qt升高(P0.05),T1～T4时点血乳酸含量升高(P0.05)。与P组比较,S组T3时点Cd降低(P0.05),T1～T2时点无明显变化(P0.05);T2～T4血乳酸含量降低(P0.05),T1～T3时RI和Qs/Qt降低(P0.05)。结论老年患者胸腹腔镜下食管癌根治术中七氟烷麻醉较异丙酚麻醉对术中肺功能和体内微循环有改善作用。

Effects of sevoflurane for one lung ventiliation on blood galact and pulmonary function during perioperative period in elderly patients undergoing esophageal carcinoma resection

Objective To investigate the effects of sevoflurane for one lung ventiliation（OLV） in elderly patients esophagetomy on blood gas and pulmonary function.Methods Forty ASA Ⅰ~Ⅲ patients aged 65~79 yr undergoing esophageal carcinoma resection were divided into 2 groups：the sevoflurane group（group S,n=20） and the propofol group（group P,n=20）.Anesthesia was induced with 6%~8% sevoflurane or the target controlled induction（TCI） concentration of propofol 2.0 mg·L-1.Anesthesia was maintained with 1%~3% sevoflurane or propofol TCI.Radial arterial blood and mixed venous blood were taken for blood gas analysis before induction of anesthesia（To）,OLV 90 min（T1）,at the end of OLV（T2）,when the abdominal was open（T3） and at the end of surgery（T4）.PA-OO2,Qs/Qt and respiratory index were calculated.Serum lactic acid concentrations were measured at T0,T2,T4.Dynamic lung compliance was calculated at T1~3.Results PA-OO2,RI and Qs/Qt at T1~3 and serum lactic acid concentrations at T1~4 were significantly increased as compared with the baseline values at T0 in both groups.In group P,Cd was significantly lower at T3 than in group S.PA-OO2 at T1~2 and serum lactic acid concentrations at T2~4,RI and Qs/Qt at T1~3 were significantly higher in group P than in group S.Conclusion Compared to propofol group,inhalation of sevoflurane in the esophageal carcinoma resection protects pulmonary function and microcirculation against OLV injury in elderly patients.Both of them are safe used in the surgery.