国际麻醉学与复苏杂志   2014, Issue (3): 5-5
    
单肺通气对七氟醚吸入麻醉肺摄取的影响
王伟芝, 罗艳华, 董桂敏, 王绍明1()
1.潍坊市人民医院麻醉科
The effect of one-lung ventilation on pulmonary uptake of sevoflurane
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摘要：

目的 观察吸入麻醉过程中单肺通气(one-lung ventilation，OLV)与双肺通气(two-lung ventilation, TLV)相比七氟醚的肺摄取情况。方法 选择食道癌根治术患者15例（OLV组）和胃癌根治术患者15例（TLV组），分别于全麻诱导后插入双腔支气管导管或单腔气管导管控制呼吸，行七氟醚吸入麻醉，记录每组病人各个时点的脑电双频指数（BIS）、七氟醚吸入气浓度（Fi）和呼出气浓度（Et），并计算Et/Fi，进行组间及组内各时间点的比较。结果 组间：OLV组BIS高于TLV组(P<0.05)；OLV组Et/Fi高于TLV组（P<0.01）。OLV组：BIS呈逐渐下降趋势，5min达到临床麻醉水平（60），5min-120min维持在临床麻醉深度(40-60)；Et呈逐渐上升趋势，30min达到稳态（30min变化无统计学意义）。Et/Fi呈逐渐升高趋势，50min达到稳态，50min-120min变化无统计学意义（P>0.05）。TLV组：BIS呈逐渐下降趋势，2min达到临床麻醉水平（60），2min-70min维持在临床麻醉深度(40-60)，70-120min低于40；Et呈逐渐上升趋势，20min达到稳态。Et/Fi呈逐渐升高趋势，2min达到稳态，2min-120min变化无统计学意义（P>0.05）。结论 OLV对七氟醚的肺摄取有一定影响。OLV摄取总量少于TLV，2min-50min摄取速率高于TLV。OLV与TLV均可达到满足手术要求的麻醉深度，但TLV组在70min后应适当调整吸入浓度以避免麻醉过深。与TLV相比，OLV麻醉深度较浅，达到稳定麻醉状态的时间较长。
关键词： 单肺通气；七氟醚；肺摄取；脑电双频指数；呼出气浓度
Abstract:

Objective To observe the effect of one-lung ventilation on takeup of sevoflurane. Methods Fifteen patients undergoing esophagus tumorectomy(one-lung ventilation,OLV) and fifteen patients undergoing stomach tumorectomy (two-lung ventilation,TLV) were selected. Either double-lumen endobronchial tube or mon-lumen tracheal tube was inserted after general anesthesia to controll ventilation. Bispectral Index(BIS), Fi and Et were recorded at each measurement point, and Et/Fi was calculated. Results The BIS value of OLV group was higher than of TLV group(P<0.05), Et/Fi of OLV group was higher than TLV group(P<0.01). OLV group: The BIS value gradually decreased and reached into anesthetic state(60) at 5 minute, and then enough anesthesia depth(BIS value =40-60) was maintained during 5-120min. Et gradually increased and reached into steady state (the change in 30 minute was no statistical significance)at 30 minute. Et/Fi increased and reached into steady state at 50 minute, and the difference of Et/Fi during 50 -120min had no statistical significance（P>0.05）. TLV group: The BIS value gradually decreased and reached into anesthetic state at 2 minute, and then enough anesthesia depth was maintained during 2-70min. However, BIS value was less than 40 after 70 minutes. Et gradually increased and reached into steady state at 20 minute. Et/Fi gradually increased and reached into steady state at 2 minute, the difference of Et/Fi during 2-120min had no statistical significance（P>0.05）. Conclusions One-lung ventilation had effect on pulmonary uptake of sevoflurane. The total amount of uptake of OLV was less than that of TLV, while uptake rate of OLV during 2-50min was faster than that of TLV. Both OLV and TLV could supply surgery-needed anesthetic depth with sevoflurane inhalant concentration 3%vol. However, inhalant concentration should be adjusted after 70 minutes to avoid excessive anesthesia during TLV. Furthermore, anesthetic depth of OLV was less than that of TLV, and OLV needed longer time to reach into steady state compared with TLV.
Key words: One-lung ventilation; Sevoflurane; Pulmonary uptake; Bispectral Index; Et