异丙酚复合瑞芬太尼应用于单肺通气麻醉的临床研究

摘要

目的 探讨异丙酚复合瑞芬太尼联合应用于单肺麻醉时对肺内分流、动脉血氧分压(PaO2)及患者清醒的影响.方法 将2009年7月～2011年7月我院住院治疗需要行肺叶切除的52 患者分为异丙酚复合瑞芬太尼静脉全麻组(A组)和静吸复合麻醉组(B 组),每组各26例.在对患者进行麻醉前、双肺通气30 min、双肺通气60 min、单肺通气60 min、再次双肺通气30 min、手术结束这6个时点分别抽取动脉血和混合静脉血进行血气分析,并观察患者的心率(HR)、平均动脉压(MAP)、开眼的时间、出现自主呼吸的时间及拔管的时间.结果 单肺通气(OLV)开始后,肺内分流率(Qs/Qt)于双肺通气(TLV)时高于麻醉前与TLV 30min 时,OLV 30min、OLV 60min 时Qs/Qt 达最高,B 组OLV 30 min、OLV 60 min 时,Qs/Qt 明显高于A 组(P < 0.05);在患者结束麻醉后,A 组开眼的时间、出现自主呼吸的时间、拔管的时间均明显短于B 组(均P < 0.01).结论 异丙酚复合瑞芬太尼麻醉不但能显著改善患者动脉血氧和减少肺内分流,而且能使患者清醒时间缩短.%Objective To Investigate the influence of anesthesia with Propofol and Remifentanil to shunt fraction (Qs/Qt), PaO2 and resuscitation after anesthesia during one-lung ventilation (OLV). Methods 52 patients receiving lobectomy in our hospital from July 2009 to July 2011 were divided into Propofol-Remifentanil anesthesia group (group A) and inhalation anesthesia group (group B), each group had 26 cases. Arterial and mixed venous blood samples were measured by hemody -namics before anesthesia, at the time of two-lung ventilation for 30 min, one-lung ventilation for 30 min (OLV 30 min), one-lung ventilation for 60 min (OLV 60 min), renew two-lung ventilation for 30 min and at the end of operation. The pa -tient's heart rate (HR), mean arterial pressure (MAP), the time of opening the eyes, the emergence time of spontaneous breathing and extubation time were observed. Results The shunt fraction (Qs/Qt) at TLV was higher than those before anesthesia and at two-lung ventilation 30 min in both groups. The Qs/Qt was highest at OLV 30 min and OLV 60 min. The Qs/ Qt of group B were higher than those of group A at OLV 30 min and OLV 60 min (P < 0.05). After the end of anesthesia, the patients of group A in the time of opening the eyes, the emergence time of spontaneous breathing and extubation time were significantly shorter than that of group B (all P < 0.01). Conclusion Propofol-Remifentanil anesthesia can improve arterial oxygen and reduced the shunt fraction during one-lung ventilation with Propofol-Remifentanil anesthesia, and can shorten patient recovery time.