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丙泊酚或七氟烷对单肺通气老年患者脑氧供需平衡的影响
Effects of propofol or sevoflurane on cerebral oxygen metabolism during one-lung ventilation in elderly patients

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DOI:
作者:
沈耀峰 徐美英 吴镜湘
SHEN Yaofeng, XU Meiying, WU Jingxiang
作者单位:
上海交通大学附属胸科医院
Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University
关键词:
丙泊酚；七氟烷；老年患者；单肺通气；脑氧供需平衡
propofol, evoflurane, elderly patient, one-lung ventilation，cerebral oxygen metabolism
摘要:
【摘要】 目的 探讨丙泊酚及七氟烷对单肺通气老年肺切除患者脑氧供需平衡的影响。方法 60例择期普胸手术的老年患者，随机分为丙泊酚组（P组，n=30）和七氟烷组（S组，n=30）。两组均以脑电双频指数（BIS）40～60为目标，应用丙泊酚或七氟烷完成麻醉。两组患者分别于诱导前（T1）、双肺通气（TLV）15min（T2）、单肺通气（OLV）30min（T3）、恢复双肺通气（rTLV）15min（T4）采集桡动脉和颈静脉球部血行血气分析，按公式计算肺内分流（Qs/Qt）、脑血流量/脑氧代谢率（CBF/CMRO2）。结果 两种麻醉方法下均顺利完成手术。OLV与TLV比较，两组动脉氧分压（PaO2）均明显下降， Qs/Qt均明显增加（P<0.05），但两组间比较无显著性差异。OLV期间S组SjvO2的明显高于P组；而CBF/CMRO2 异常的发生率则S组高于P组（60% vs 30%）。结论 OLV期间，BIS 40～60，七氟烷并未显著抑制HPV，与丙泊酚相比对机体氧合影响没有明显差异。丙泊酚组脑氧供氧需匹配良好，优于七氟烷组。
【Ab【Abstract】 Objective To investigate the effects of propofol and sevoflurane on cerebral oxygen supply and demand equilibrium during one-lung ventilation in elderly patients undergoing thoracic surgery. Methods Sixty elderly patients scheduled for elective thoracic surgery under general anesthesia were randomly divided into propofol group(group P) or sevoflurane group(group S). During operation bispectral index (BIS) was maintained at 40-60. Samples of blood gas analysis were collected from the radial artery and jugular bulb in T1 (before induction)、T2 (15min after two lung ventilation (TLV))、T3 (30min after one lung ventilation (OLV))、T4 (15min after rTLV)，Qs/Qt and the ratio of cerebral blood flow to cerebral oxygen metabolic rate (CBF/CMRO2) were calculated. Result Compared with time of TLV, PaO2 of two groups were decreased during OLV, and QS/QT were obviously increased (P<0.05), but differences between two groups were not obvious. SjvO2 during one-lung ventilation was significantly higher in group S (P<0.05), and the incidence of abnormal CBF/CMRO2 was higher in group S. Conclusions Compared with propofol, sevoflurane didn’t obviously inhibit HPV or effect oxygen oxygen supply and demand equilibrium when BIS was maintained at 40-60. Effects of propofol on cerebral oxygen metabolism was less than that of sevoflurane during OLV.

 

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