摘要
目的观察胸段硬膜外阻滞复合全麻对单肺通气期间气体交换的影响。方法随机选择ASAⅠ～Ⅱ级择期开胸手术病人80例，将病人随机分为两组，全麻复合硬膜外麻醉组（A组）和全麻组（B组），每组40例。两组病人在开胸前双肺通气20min（T1）时及开胸后单肺通气（OLV）30min（T2）、60min（T3）、120min（T4）时，分别采动脉血及混合静脉血，观察病人动静脉血气情况并计算肺内分流率（Qs/Qt）值、肺泡-动脉血氧分压差（A-aDO2）和无效腔量／潮气量（Vd／Vt）值。结果与T1相比，两组T2-4时Paw均升高（P〈0．01），T2-4时Qs／Qt均增加（P〈0．01），A-aDO2增加（P〈0．01），PaO2降低（P〈0．01），而Vd／Vt，血压、心率变化无统计学差异（P〉0．05）；与B组相比，A组T2-4时的Qs／Qt增加（P〈0．01），A—aDO2增加（P〈0．01），PaO2降低（P〈0．01），而Vd／Vt，血压、心率变化无统计学差异（P〉0．05）。结论单肺通气期间硬膜外阻滞复合全麻对肺换气功能有影响，使Qs／Qt增加，PaO2下降，A—aDO2增大；对肺泡通气功能指标Vd／Vt影响甚微。
Objective To evaluate the effects of general anesthesia combined with throacic epidural block on pulmonary gas exchange during one-lung ventilation in patients undergoing thoracic surgery. Methods Eighty patients of ASA Ⅰ - Ⅱ undergoing elective throacic surgery were randomly divided into two Groups （ n = 40） receiving combined general anesthesia with throacic epidural block （group A） or general anesthesia （group B）. MAP, HR, SpO2, PETCO2, VT, Paw were monitored at both broups. Arterial and mixed vein blood gas were analyzed and Qs/Qt,A-aDO2 ,Vd/Vt were calculated in both groups at 20 min （ T1 ） before one-lung ventilation and 30 rain （ T2 ）, 60 rain（ T3 ）, as well as 120 rain （ T4 ） after one-lung ventilation. Results In both groups, Paw and Qs/Qt increased while PaO2 decreased significantly at T2-4 （ P 〈 0.05 ）. At T2-4, Qs/Qt was significantly higher and PaO2 was significantly lower in group A than that in group B. Conclusion During one-lung ventilation, general anesthesia combined with throacic epidural block has increased Qs/Qt ,A-aDO2 ,Vd/Vt and decreased PaO2. The patients should be monitored carefully during all the surgical procedure.
出处
《国际麻醉学与复苏杂志》
CAS
2008年第5期398-401,共4页
International Journal of Anesthesiology and Resuscitation
关键词
单肺通气
硬膜外阻滞
全麻
气体交换
one-lung ventilation
general anesthesia
epidural block
pulmonary gas exchange
