七氟醚及丙泊酚对单肺通气患者局部脑氧饱和度影响的比较

摘要

目的 比较七氟醚吸入麻醉和丙泊酚全凭静脉麻醉对胸科手术单肺通气(OLV)患者局部脑氧饱和度(rSO2)及血流动力学的影响.方法 选择择期行肺叶/段切除或纵隔肿物切除手术的患者40例,ASA Ⅰ或Ⅱ级,随机均分为两组:七氟醚组(S组)和丙泊酚组(P组).S组:8％七氟醚吸入诱导；P组:丙泊酚静脉诱导,血浆靶浓度设为4.5 μg/ml,当Narcotrend数值降至80后,静注维库溴铵0.15 mg/kg和芬太尼3 μg/kg,Narcotrend数值降至55以下且TOF为0时,行双腔气管插管.术中维持:S组吸入浓度为1.5％～4.0％七氟醚,P组丙泊酚血浆靶浓度2.5～5.0 μg/ml,维持Narcotrend在26～55,间断静注芬太尼和维库溴铵.记录两组诱导时间及诱导前(T0)、诱导后4 min(T1)、插管即刻(T2)、插管后5 min(T3)、手术切皮(T4)、OLV 30 min(T5)、OLV 60 min(T6)、手术结束(T7)时的MAP、HR、SpO2、左、右侧rSO2值.结果 与T0时比较,T1～T7时S组、T1和T3～T6时P组患者MAP明显降低(P＜0.05)；T1～T4和T7时两组患者SpO2明显升高(P＜0.05)；T2、T3时两组患者左、右侧rSO2明显升高(P＜0.05)；T1～T7时S组HR差异无统计学意义.与P组比较,T2、T6、T7时S组患者MAP明显降低(P＜0.05)；T3～T6时左侧和T4、T7时右侧S组患者的rSO2明显升高(P＜0.05).S组诱导时间(6.38±0.81) min明显长于P组(5.56±1.20) min(P＜0.05).结论 与丙泊酚全凭静脉麻醉比较,七氟醚吸入麻醉患者的rSO2较高,有助于增加围术期的脑氧灌注,且血流动力学更平稳,但诱导时间长.%Objective To compare the effects of sevoflurane and propofol anesthesia on regional cerebral oxygen saturation index and hemodynamics in patients underwent one lung ventilation. Methods Forty ASA I or Ⅱ patients underwent elective pulmonary or mediastinal tumor resection surgery were randomly divided into 2 groups (n= 20 each): group sevoflurane (group S) and group propofol (group P). Anesthesia was induced with inhalation of 8%sevoflurane in group S or target-controlled infusion of propofol (4. 5 μg/ml) in group P, until the Narcotrend decreased to 80,then vercuronium 0. 15 mg/kg and fentany 3 μg/kg was administered. When the Narcotrend decreased under 55 and the TOF was 0, double lumen tube was intubated. Anesthesia was maintained with either 1. 5%-4. 0% sevoflurane or 2. 5-5. 0 μg/ml propofol in each group to maintain Narcotrend values between 26 and 55. MAP,HR,Sp O2 ,rSO2 were recorded at the following time points: before induction(T0) , 4 min after induction (T1), immediate after intubation (T2), 5 min after intubation (T3),incision(T4),30 min(T5),60 min after one lung ventilation(T6) ,end of the surgery(T7)in both groups. Results Compared with T0, MAP at T1 -T7 in group S and T1, T3 -T6 in group P were significantly decreased (P<0. 05) ,SpO2 at T1-T4 and T7 ,rSO2 at T2 ,T3 in both the two groups were obviously increased (P<0. 05). Compared with group P,MAP in group S was significantly lower at the time of T2 ,T6 ,T7 (P<0. 05) ,and the duration of induction was longer than group P (P<0. 05). Left side regional cerebral oxygen saturation index was significantly higher than those in group P at the following time points:T3-T6 (P<0. 05), while right side regional cerebral oxygen saturation index was higher than group P at T4 T7 (P