摘要
目的观察瑞芬太尼对下肢手术患者因止血带应用导致的肺换气功能影响。方法择期拟全身麻醉下用止血带行单侧膝以下的下肢手术患者45例,ASA分级Ⅰ～Ⅱ级,止血带充气时间1～1.5 h。随机分为三组(n=15):不同剂量瑞芬太尼组R1、R2组和对照组(C组);R1、R2组麻醉维持期间分别输注瑞芬太尼0.2μg.kg-1.min-1和0.4μg.kg-1.min-1,C组患者用七氟醚维持麻醉在麻醉诱导前(T0)、松止血带后30 min(T1)、4 h(T2)、24 h(T3)取桡动脉血行血气分析,并计算肺泡-动脉血氧分压差(PA-aDO2)和呼吸指数(RI)。结果 T2与T0时比较,三组患者PaO2降低,PA-aDO2和RI升高,差异均有统计学意义(t分别=6.19、4.08、2.32;10.94、7.10、4.98;8.46、5.97、3.61,P均<0.05)。T2时,R2组与R1组比较、R2组与C组比较、R1组与C组比较,PaO2升高,差异均有统计学意义(t分别=2.38、2.35、5.1,P均<0.05),而PA-aDO2和RI降低,差异均有统计学意义(t分别=3.15、4.29、8.08;3.05、3.00、7.14,P均<0.05)。三组患者各时点PaCO2比较,差异均无统计学意义(t分别=1.45、0.16、0.07;0.12、1.10、1.10,P均>0.05)。结论下肢手术患者用止血带后肢体缺血再灌注可以导致肺换气功能损伤。瑞芬太尼可以减轻其损伤。
Objective To evaluate the effect of remifentanil on pulmonary gas exchange following tourniquet deflation in patients undergoing lower extremity surgery. Methods Forty-five ASA I or II patients scheduled for unilateral lower extremity surgery, whose tourniquet inflation duration varied from 1.0 hour to 1.5 hours received total anesthesia and were randomly divided into 3 groups （n=15 each）： different dose of remifentanil groups （group R1.2） and control group （group C ）. Anesthesia was maintained with sevoflurane in group C; group R1 and R2 were maintained with remifentanil at a rate of 0.2 μg·kg-l·min-1 and 0.4 μg·kg-l·min-1. Radial arterial blood samples were collected immediately before anesthesia performed （To）, 1 hour（T1 ） ,4 hours （T2） and 24 hours （Ts） after tourniquet deflation for blood gas analysis. Alveolo-arterial oxygen partial pressure difference（PA-aDO2） and respiratory index（RI） were calculated. Results Compared with the baseline values at To, arterial partial pressure of oxygen（PaO2） at T2 were significantly decreased, while PA-aDO2 and RI were significantly increased （t=6.19, 4.08, 2.32;10.94, 7.10, 4.98;8.46, 5.97, 3.61, P〈0.05）.Between groups of R2 and R1, R2 and C, R1 and C, PaO2 was significantly increased at T2（t=2.38,2.35,5.1 ,P〈0.05）, PA-aDO2 and RI were significantly de- creased （t=3.15, 4.29, 8.08;3.05, 3.00, 7.14, P〈0.05）. No significant changes in PaC02 were observed within and between groups （t=1.45, 0.16, 0.07;0.12, 1.10, 1.10, P〉0.05）. Conclusions Limb ischemia-reperfusion leads to pulmonary gas exchange impairment. Pulmonary gas exchange impairment following tourniquet deflation could be attenuated by remifentanil.
出处
《全科医学临床与教育》
2012年第2期155-158,共4页
Clinical Education of General Practice
关键词
瑞芬太尼
止血带
肺换气
remifentanil
tourniquet
pulmonary gas exchange
