摘要
目的评价羟考酮预处理对胸科手术患者单肺通气时肺内分流和氧合的影响。方法选取择期胸科手术单肺通气患者40例,分为对照组和羟考酮组,每组各20例。单肺通气前15 min,羟考酮组静脉注射5 ml混合液(0.1 mg/kg羟考酮+0.9%氯化钠),对照组静脉注射等容量0.9%氯化钠注射液。调节吸入七氟醚浓度保持脑电双频指数(BIS)值在40~60之间。分别于单肺通气前即刻(T_1)、单肺通气后10 min(T_2)、20 min(T_3)和30 min(T_4)时,行血气分析计算肺内动静脉分流率(Qs/Qt),并记录各时间点的酸碱度(pH)、血氧饱和度(PaO_2)、血二氧化碳饱和度(PaCO_2)、平均动脉压(MAP)值等。结果两组患者T_1、T_2、T_3、T_4时p H值、PaCO_2、BIS值比较,差异无统计学意义(t分别=0.78、0.03、0.73、0.49;0.98、0.88、0.71、0.55;0.80、0.47、0.56、0.65,P均>0.05);两组T_1、T_2、T_4时MAP比较,差异亦无统计学意义(t分别=1.34、1.24、0.56,P均>0.05)。与T_1时比较,羟考酮组和对照组T_2、T_3、T_4时Qs/Qt明显增加,PaO_2明显降低,差异均有统计学意义(t分别=14.69、12.25、16.55、11.82、20.45、16.24;15.47、20.89、18.34、14.23、17.63、17.70,P均<0.05)。与对照组比较,羟考酮组T_2、T_3、T_4时Qs/Qt降低,T_2、T_4时Pa O2升高,差异有统计学意义(t分别=4.52、6.89、4.85;4.63、0.98,P均<0.05);羟考酮组T_1、T_3、T_4时呼末七氟醚浓度(ET_sev)较对照组均明显减少,差异有统计学意义(t分别=7.08、6.87、5.05,P均<0.05)。结论单肺通气前静脉注射羟考酮注射液0.1 mg/kg预处理可减少七氟醚的用量,减轻单肺通气时肺内分流,提高氧合。
Objective To investigate the effect of pretreatment with oxycodone on intrapulmonary shunt and arterial partial pressure of oxygen in patients undergoing thoracic surgery during one-lung ventilation. Methods Forty patients undergoing elective thoracic surgery were assigned into oxycodone group and control group with 20 cases in each. At 15 minutes before one-lung ventilation,the 0.1 mg/kg of oxycodone mixed with 5 ml normal saline was injected intravenously in oxycodone group,while the control group the equal volume of normal saline. Sevoflurane concentration were adjusted to maintain BIS from 40 to 60. At immediately before one-lung ventilation（T_1）,at 10 min（T_2）,20 min（T_3）and 30 min（T_4）after one-lung ventilation,the potential of hydrogen（p H）,PaO_2,Pa CO_2,MAP of two groups were detected and intrapulmonary shunt（Qs/Qt）were calculated. Results There were no significant differences in p H value,PaCO_2 and BIS at T_1,T_2,T_3,T_4 between the two groups as well as MAP at T_1,T_2,T_4（t=0.78,0.03,0.73,0.49,0.98,0.88,0.71,0.55,0.80,0.47,0.56,0.65,1.34,1.24,0.56,P〈0.05）. Compared with T_1,Qs/Qt was significantly higher,while PaO_2 was significantly lower at T2,T3,T4 in oxycodone group and control group（t=14.69,12.25,16.55,11.82,20.45,16.24; 15.47,20.89,18.34,14.23,17.63,17.70,P〈0.05）. Compared with the control group,Qs/Qt was significantly lower at T2,T3,T4 and PaO_2 was significantly higher at T_2,T_4 in oxycodone group（t=4.52,6.89,4.85,4.63,0.98,P〈0.05）. ETsev in oxycodone group was significantly lower than control group at T_1,T_3,T_4（t=7.08,6.87,5.05,P〈0.05）. Conclusion Intravenous pre-injection 0.1 mg/kg of oxycodone at 15 minutes before one-lung ventilation can reduce the intrapulmonary shunt and increase the arterial partial pressure of oxygen during one-lung ventilation in patients undergoing thoracic surgery.
出处
《全科医学临床与教育》
2017年第6期614-617,625,共5页
Clinical Education of General Practice
基金
2015年浙江省湖州市卫生局科研计划项目(2015GY16)
关键词
羟考酮
单肺通气
肺内分流
七氟醚
oxycodone
one-lung ventilation
intrapulmonary shunt
sevoflurane
