Yondov D, Kounev V, Ivanov O, Prisadov G, Semerdjieva M
Department of Anaesthesiology, Reanimation and Intensive Care, Higher Medical Institute, Plovdiv, Bulgaria.
Folia Med (Plovdiv). 1999;41(3):45-51.
Conducting one lung ventilation (OLV) in thoracic surgery highlights the issue of the onset (prevention and treatment) of clinically significant arrhythmogenic hypoxemia. The halogenated volatile anaesthetics are the drugs of choice in thoracic surgery despite the numerous experimental data showing their inhibiting effect on the hypoxic pulmonary vasoconstriction (HPV). The intravenous anaesthetic agent propofol has not been shown to influence this reflex mechanism. The object of the present study was to compare in clinical conditions the arterial oxygenation in patients undergoing noncardiac thoracic procedures, requiring a period of one lung ventilation during general anaesthesia with volatile anaesthetics halothane, isoflurane and total intravenous anaesthesia (TIVA) with propofol/fentanyl.
The study included 45 patients divided in three groups consisting of 15 anaesthetized subjects each: group A--halothane; group B--isoflurane and group C--propofol/fentanyl. Arterial blood samples for blood-gas analysis were taken as follows: first probe (T1)--after two lung ventilation (TLV) was maintained for 15 min., second probe (T2)--after 45 min. of stable OLV and the third probe (T3)--during wound closure. The changes in PaO2 were statistically analyzed using the methods of descriptive and dispersion analyses.
A significant decrease in PaO2 during stable OLV compared with TLV (P < 0.05) was found in patients of all three groups. There was no significant difference in PaO2 between the subjects in the three groups during respective regimens of ventilation.
TIVA with propofol/fentanyl can be successfully applied in thoracic surgery as an alternative of general anaesthesia with halogenated volatile anaesthetics.
胸外科手术中进行单肺通气（OLV）凸显了具有临床意义的致心律失常性低氧血症的发生（预防和治疗）问题。尽管有大量实验数据表明卤化挥发性麻醉剂对缺氧性肺血管收缩（HPV）有抑制作用，但它们仍是胸外科手术的首选药物。静脉麻醉剂丙泊酚尚未显示出对这种反射机制有影响。本研究的目的是在临床条件下比较接受非心脏胸科手术的患者在使用挥发性麻醉剂氟烷、异氟烷进行全身麻醉期间需要单肺通气一段时间以及使用丙泊酚/芬太尼进行全静脉麻醉（TIVA）时的动脉氧合情况。
该研究包括45例患者，分为三组，每组15例麻醉受试者：A组——氟烷；B组——异氟烷；C组——丙泊酚/芬太尼。用于血气分析的动脉血样本采集如下：第一个样本（T1）——在双肺通气（TLV）维持15分钟后；第二个样本（T2）——在稳定的OLV 45分钟后；第三个样本（T3）——在伤口缝合期间。使用描述性和离散性分析方法对动脉血氧分压（PaO2）的变化进行统计学分析。
在所有三组患者中，与TLV相比，稳定OLV期间PaO2均显著降低（P < 0.05）。在各自的通气方案期间，三组受试者的PaO2之间无显著差异。
丙泊酚/芬太尼全静脉麻醉可作为卤化挥发性麻醉剂全身麻醉的替代方法成功应用于胸外科手术。
