目的:比较瑞芬太尼和七氟烷用于老年患者开胸手术行单肺通气时肺内分流和氧代谢的变化情况.方法:将40例老年食道癌患者随机分为瑞芬太尼组(R组)和七氟烷组(S组)各20例.经全身麻醉诱导后行右双腔支气管插管.在麻醉维持中持续靶控输注丙泊酚(靶控浓度)2～6 mg/L,R组持续静脉输注瑞芬太尼0.1～0.15μg/(kg·min),S组持续吸入2％～3％七氟烷,间断静脉注射顺式阿曲库铵维持肌松.分别于单肺通气15、30、60、90 min、恢复双肺通气15 min时测定动、静脉血气.结果:与双肺通气相比,两组单肺通气时气道峰压升高、肺内分流量增加、氧合能力降低(P＜0.05).两组间气道峰压升高、肺内分流量增加、氧合能力比较差异无统计学意义.两组清醒时间、拔管时间及不良反应发生率比较差异无统计学意义.结论:瑞芬太尼用于老年患者开胸手术行单肺通气,对肺内分流和氧代谢的影响与七氟烷相比无差异,其能为单肺通气患者提供稳定的血流动力学状态.%Objective: To compare the effect of remifentanil with sevoflurane on oxygenation and intrapulmo-nary shunt during one-lung ventilation for senile patients. Methods: Forty senile patients with esophageal cancer were randomly divided into remifentanil group (group R; n = 20) and sevoflurane (group S: n = 20). When anesthesia was induced right-sided double-lumen endobronchial tube (R-DLT) was intubated orally. Then anesthesia was maintained with remifentanil 0. 1 ~0. 15μg/ (kg · min) in group R, and with 2% ~3% sevoflurane inhalation in group S respectively. The other drugs used in both groups for anesthesia maintenance were target- controlled infusion of propofol 2-6 mg/L (plasma concentration). The arterial and mixed venous blood samples were drawn for blood gas analysis and intrapulmonary shunt calculations were taken at the following time; 15 min after two-lung ventilation, 15, 30, 60 and 90 min after one-lung ventilation and 15 min after returning to two-lung ventilation in both groups. Resu The shunt fraction (Qs/Qt) and Ppeak were significantly higher and PaO2 was significantly lower in one-lung ventilation than in two-lung ventilation ( P < 0. 05). There was no statistical difference in Ppeak, Qs/Qt, PaO2, recovery time, extubation time and complications between two groups. Conclusion: There was no statistical difference between remifentanil and sevoflurane in oxygenation and intrapulmonary shunt during one-lung ventilation for senile patients. Anesthesia with remifentanil can provide stable hemodynamics and fast consciousness for elderly patients undergoing thoracic surgery.
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