硬膜外阻滞对全麻单肺通气期间肺内分流和氧合的影响

被引：19

作者：

冯艺

孙颖

杨拔贤

机构：

[1] 北京大学人民医院麻醉科

来源：

中华麻醉学杂志 | 2002年 / 03期

关键词：

呼吸,人工; 麻醉,硬膜外; 麻醉,全身; 肺循环;

D O I：

暂无

中图分类号：

R614.42 [];

学科分类号：

100217 ;

摘要：

目的本研究旨在通过比较全凭静脉麻醉和静脉复合胸部硬膜外麻醉时单肺通气期间肺内分流和动脉氧合的变化,探讨硬膜外麻醉对肺内分流和氧合的影响。方法24例因肺癌或食管癌需单肺通气开胸手术病人,根据麻醉方法的不同随机分为全凭静脉组（GA,n=12,异丙酚/芬太尼/维库溴铵麻醉）和静脉复合硬膜外组（GE,n=12,异丙酚/维库溴胺/胸部硬膜外0.5％罗哌卡因麻醉）。连续监测MAP,MPAP,CO,ECG,HR,SpO2。分别于清醒时、双肺通气30min、单肺通气5,15,30,和60 min、再次双肺通气30 min、抽取动脉、混合静脉血血样,测定血气和肺内分流率（Qs/Qt）。结果单肺通气后,Qs/Qt进行性增加,至15～30min时达到高峰（分别为GA-33.4％和GE-32.4％）,GA组和GE组各时间点肺内分流差异无显著性。GA组和GE组单肺通气时PaO2较双肺通气明显下降,至 15～30 min时最低（分别为 165.1mm Hg和 168.7 mm Hg）,但两组各时间点PaO2差异无显著性。除GE组平均动脉压轻度降低外,两组心输出量和心率在整个试验中波动不明显。结论胸部连续硬膜外阻滞不会影响静脉全麻单肺通气期间肺内分流和动脉氧合,可安全有效用于开胸手术。

引用

页码：15 / 19

页数：5

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