摘要
目的比较七氟醚和异丙酚麻醉对老年患者单肺通气(OLV)期间脑氧饱和度(rSO2)的影响。方法104例行择期胸科手术并需OLV的老年患者(年龄>60岁),随机分为七氟醚吸入麻醉组(S组,n=52)和异丙酚静脉麻醉组(P组,n=52),清醒、麻醉至拔出气管导管期间,选择双肺通气后15 min(T1)、单肺通气后15 min(T2)、30min(T3)、60 min(T4)、90 min(T5)、120 min(T6)、双肺通气后15 min(T7)等不同时间点,记录左、右侧rSO2值、双频指数(BIS)、心率、血压、脉搏氧饱和度(SpO2)、呼气末二氧化碳等指标的变化情况,并采集桡动脉血行血气分析。结果 OLV时不同时间点的rSO2值均明显小于双肺通气时(均P<0.05)。七氟醚组各时间点的rSO2值均比异丙酚组高,但差异均无统计学意义(均P<0.05)。异丙酚组的rSO2≤45%例数、rSO2≤45%的总时间、rSO2≤45%的最长时间、rSO2≤45%整合值均明显大于七氟醚组(均P<0.05)。结论正常通气状态下七氟醚和异丙酚对rSO2无影响,但OLV时都有不同程度的下降,且七氟醚下降幅度低于异丙酚,常规OLV时监测如SpO2或心率等尚不足以检测到rSO2明显不佳的现象。
Objective To compare the incidence of reduction of the cerebral oxygen saturation （ rSO2 ） uring one-lung ventilation （OLV） in general anesthesia maintained with sevoflurane or propofol in elderly patients. Methods One hundred and four patients with routine elective thoracic surgery which need for OLV in elderly patients （age 〉 60 years） were randomly divided into the sevoflurane group （ group S, n = 52） and the propofol group （ group P, n = 52）. In the period of from being awakening to tracheal tube pulling-out, values of left and right rSO2, BIS, heart rate, blood pressure, oxygen satura- tion, end-tidal carbon dioxide were recorded every 5 min. Meantime arterial samples were measured. Re- sults In the two groups, values of rSO2 for OLV were less than the values for double lung ventilation （ all P 〈 0.05）. Ahhrough in the group S the rSO2 values were higher than those in the group P in various time, difference was not observed （ all P 〉 0.05 ）. In the group P, the number, total time, the longest time and the integrational values of rSO2 which was less than or egual to 45 % were higher than those in the group S（ all P 〈 0.05）. Conclusion Sevoflurane or propofol has no effect on the cerebral oxygen balance during normal ventilation, OLV desaturation of rSO2 is more frequent occurred during OLV under propofol versus sevoflurane-based anesthesia. Conventional monitoring during saturation or heart rate etc is insuflqcient to detect phenomenon of desaturation OLV such as pulse oxygen of rS02.
出处
《苏州大学学报（医学版）》
CAS
2012年第3期410-413,419,共5页
Suzhou University Journal of Medical Science
关键词
老年
胸部手术
七氟醚
异丙酚
脑氧饱和度
elderly
thoracic surgery
sevoflurane
propofol
cerebral oxygen saturation
