摘要
我们观察17例胸内手术病人用双腔管进行单侧肺通气时,肺内分流和PaO2变化,以及吸入氧浓度对PaO2的影响,以寻求适合我国临床麻醉的方法。FIO2为1.0和0.7时,于进胸后和单侧通气后30和60min时测动脉血气,计算A-aDO2和Qs/Qt。结果:(1)PaO2:FIO2=1.0时,进胸后下降,单侧肺通气后下降更显著(P<0.001)。但均在13.3kPa(100mmHg)以上。FIO2=0.7时,PaO2均明显下降,最低为10.9kPa(82mmHg)。(2)A-aDO2和Qs/Qt:进胸后增加,单侧肺通气后更显著。Qs/Qt为18.52％。(3)PaCO2和pH无明显变化。以上结果提示:(1)进胸后,FIO2=0.7足以维持PaO2在13.3kPa(100mmHg)以上。(2)单侧肺通气时0s/Qt增加,FIO2=0.7时,PaO2下降明显。但都在临床所允许的范围以内。且单肺通气后30和60min时的PaO2值很相近。我们认为术前病人无明显心肺功能障碍,FIO2在0.7以上,麻醉管理适当,用双腔管行单肺通气1 h以内,能维持正常的动脉血氧合和CO2排出,不需用其它方法升高PaO2。
The changes in Qs/Qt, PaO2 and the effect of supplemental oxygen on PaO2 during one-lung aneasthesia were observed in 17 patients undergoing intrathoracic surgery. Results of measured blood gases, calculated A-aDO2 and Qs/Qt were recorded after entering the pleural cavities and at intervals of 30 and 60 minutes after one-lung anesthesia. When FiO2 was 1.0, PaO2 fell after entering the pleural cavities and decraassd further during one-lung anesthesia, but PaO2 exceeded 100 mmHg. When FiO2 was adjusted to 0.7, PaO2 fell significantly and decreased to 82 mmHg in an individual case. A-aDO2 and Qs/Qt increased after entering the pleural cavities and raised further during one-lung anesthesia (Os/Qt = 18.52%), but both were still within clinic ally acceptable ranges. PaO2 changed slightly within 60 minutes under one-lung anesthesia. It is concluded that one-lung anesthesia might maintain normal arterial oxygenation and CO2 tension in patients without significant pre-existing pulmonary and cardiovascular dysfunction, if it is well managed with FiO2 more than 0.7 and the time of one-lung anestesia not over one hour, and there is no need of using other methods to increase PaO2.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
1989年第3期132-136,共5页
Journal of Clinical Anesthesiology
