| 【Backgroud and Objective】One-lung ventilation(OLV) was a special kind of ventilation during chest surgery, because the unventilation side had a flow without adequate oxygenation circulation into the left heart, lead to the venous blood joined in arterial oxygen saturation(SaO2) and the arterial blood pressure(PaO2) in blood was reduced. It could be rised up hypoxia pulmonary vasoconstriction mechanism when the hypoxia signal was occurred, to ensure the minimum pulmonary blood shunt(Qs/Qt)and reduce the occurrence of hypoxemia.But the hypoxia pulminary vasocostriction(HPV) itself could be influenced by such as temperature, trauma, and the anesyetic.In this study, we tried to compare many factors during in surgery with different anesthesia menthods, to analyze the influence of one-lung ventilation on oxygen saturation of lung cancer patients under intravenous inhalational anesthesia. 【Materials and methods】1 ObjectiveSelected 128 cases lung cancer patients who choice lung excision as our objective, including male 82 cases,female 46 cases; Age was 40~65, Height: 160~180cm; Weight : 55~80kg, 60 cases tumor in left cancer and the rest in right; 68 cases mild ventilatory disorder, 40 cases middle and 6 cases heavy; ASA classify was Ⅱ~Ⅱ, 106 cases were Ⅱ and the rest were Ⅱ.The diagnose creteria was according to <Thoracic Sugery>, all the patients were need lung excision, and these patients were divided into teo groups according to their anethesia methods with 64 cases each: Intravenous combined inhalation anesthesua(Objective) and Propofol combined Fentany TIVA(Control).2 Anethesia MethodThe objective group using intravenous combined inhalation anesthesua: first, taking 3mg mdazolam by intravenous drip, the instill 1~2mg/kg propofol, remifentani 2μg/kg,vecuronium bromide 0.1~0.2mg/kg after sleep, trachea cannula after denitrify 3 min; then maintain the anetheua state using continously 1%~3% insofurane, 0.1~0.25/( Kg·min) remifentani, and discontinously 2mg/time vecuronium bromide. Control group using profol combined fentany method: first, taking 3mg mdazolam by intravenous drip, the instill 1~2mg/kg propofol, remifentani 2μg/kg, vecuronium bromide 0.1~0.2mg/kg after sleep, trachea cannula after denitrify 3 min; then maintain the anetheua state using continously0.1~0.25μg/(kg·min)remifentani, 6~12mg/(kg·h) propofol, and discontinously 2mg/time vecuronium bromide.3 Detection index(1) Ambulatory blood pressure( ABP)、 Bispectral index( BIS)、Electrocardiograph(ECG)、Heart rate(HR)、Aterial Oxygen saturation(SaO2)、nasopharynx temperature、End tidal carbon dioxide(PetCO2), and so on;(2) Record the surgery time, one-lung ventilation time during surgery, awake time and drawing tube timeof these two group;(3) Served the time of anesthesia before as T0, the time of intubation 15 min after as T1, the time of one-lung ventilation 45 min after as T2, the time of two-lung ventilation after 15 min as T3, record the heart rate(HR)、mean arterial pressure(MAP)、Aterial oxygen saturation(SaO2)、Aterial oxygen pressure(PaO2),bisepctral index(BIS)et al related index on T0、T1、T2、T3 times,then calculation the pulmonary shunt fraction( Qs/Qt);(4) Record the usage of vasoactive agents during surgery in these two groups;(5) Record the occurrence of adverse reaction in these two groups. 【Result】1 There were no statistical differences of age, gender, ASA class, tumor staging and height in two groups(P>0.05),means that had a comparability between two groups;2 There were no statistical differences of surgery location and surgery time in two groups(P>0.05),but the awake time and drawing tube time of intravenous inhalational anesthesia group were later than propofol combined remifentani group(P<0.05);3 The heart rate(HR) of two groups had no statistic significance before surgery, with the advanced time, the score of heart rate(HR) was declined significantly,and the heart rate(HR) of intravenous inhalational anesthesia group was lower than propofol combined fentany group;The mean arterial pressure(MAP)of two groups were had no obvious difference before surgery, but reduced during surgery(P<0.05),and had no obvious different between two groups on the same time(P>0.05);4 On the T2 time of one-lung ventilation( OLV), the aterial oxygen saturation(SaO2) and Aterial oxygen pressure(PaO2) were siginificantly reduced(P<0.05),and these in intravenous inhalational anesthesia group was lower than propofol combined fentany group(P<0.05);PcvO2 in these two group had no change;On the T2 time of one-lung ventilation( OLV),pulmonary shunt fraction(Qs/Qt) of these groups was obviously rose up,these in intravenous inhalational anesthesia group was higher than propofol combined fentany group(P<0.05);5 The usage amount of ephedrine, nitroflycerin and esmolol in these two groups had no statisitic difference, but the usage of atropine in propofol combined fentany group was lower than intravenous inhalational anesthesia(P<0.05);6 The adverse raction rate of nausea, delayed recovery,agitation when dawing tube of theses two groups had no statistical differences(P>0.05). 【Conclusion】On the condition of one-lung ventilation(OLV), the intravenous inhalational anesthesia have no advantages compared with propofol combined with remifentani group:1.The awke time and drawing tube time after surgery is longer.2.The arterial oxygen saturation(SaO2) and arterial oxygen pressure(PaO2) is lower.3.The the hypoxia pulminary vasocostriction(HPV) of lung cancer patients are inhibited and the Qs/Qt is increased... |
PDF Full Text Request