Iwata Masato, Inoue Satoki, Kawaguchi Masahiko, Takahama Makoto, Tojo Takashi, Taniguchi Shigeki, Furuya Hitoshi
Department of Anesthesiology, Nara Medical University, Nara, Japan.
J Cardiothorac Vasc Anesth. 2008 Feb;22(1):71-6. doi: 10.1053/j.jvca.2007.03.012. Epub 2007 Jun 27.
During one-lung ventilation (OLV), systemic oxygenation can be compromised. In such a scenario, if anesthetic techniques were used that adversely affected cerebral oxygen balance, the risk for impaired cerebral oxygen balance may be increased. In this study, jugular bulb venous oxygen saturation (SjO(2)) during OLV under sevoflurane- or propofol-based anesthesia for lung surgery was investigated.
Prospective clinical study.
University hospital.
Fifty-two adult patients scheduled for elective thoracic procedures in the lateral position.
Patients were randomly allocated to either the sevoflurane or propofol group (n = 26). General anesthesia was maintained with sevoflurane or propofol combined with epidural anesthesia.
Arterial and jugular bulb blood samples were measured before OLV, 15 minutes after OLV, 30 minutes after OLV, and 15 minutes after the termination of OLV. SjO(2) values in both sevoflurane and propofol groups significantly declined during OLV (p < 0.05). SjO(2) values in the sevoflurane group were higher than in the propofol group, although SaO(2) values were similar (p < 0.05). Regarding the incidence of SjO(2) <50% (cerebral oxygen desaturation), there were significant differences between the sevoflurane group and the propofol group during both normally ventilated conditions (0% v 7.7%, p < 0.05, relative risk [RR]: not applicable) and OLV (1.9% v 26.9%, p < 0.05, RR = 14; 95% confidence interval [CI] 1.91-103). Significant increase in the incidence of SjO(2) <50% during OLV was also observed only in the propofol group (from 7.7% to 26.9%, p < 0.05, RR = 3.5; 95% CI 1.29-12.4).
Cerebral oxygen desaturation was more frequently detected during OLV under propofol- versus sevoflurane-based anesthesia. Cerebral oxygen balance during OLV for lung surgery was less impaired under sevoflurane-based anesthesia compared with propofol; however, the clinical outcome or implications for cognitive function need to be determined.
在单肺通气（OLV）期间，全身氧合可能会受到影响。在这种情况下，如果使用的麻醉技术对脑氧平衡产生不利影响，那么脑氧平衡受损的风险可能会增加。在本研究中，对肺手术中七氟醚或丙泊酚麻醉下OLV期间的颈静脉球血氧饱和度（SjO₂）进行了研究。
前瞻性临床研究。
大学医院。
52例计划行择期胸科手术的成年患者，手术时取侧卧位。
患者被随机分为七氟醚组或丙泊酚组（n = 26）。全身麻醉采用七氟醚或丙泊酚联合硬膜外麻醉维持。
在OLV前、OLV后15分钟、OLV后30分钟以及OLV结束后15分钟采集动脉血和颈静脉球血样本。七氟醚组和丙泊酚组的SjO₂值在OLV期间均显著下降（p < 0.05）。尽管动脉血氧饱和度（SaO₂）值相似，但七氟醚组的SjO₂值高于丙泊酚组（p < 0.05）。关于SjO₂<50%（脑氧饱和度降低）的发生率，在正常通气条件下（0%对7.7%，p < 0.05，相对危险度[RR]：不适用）和OLV期间，七氟醚组和丙泊酚组之间均存在显著差异（1.9%对26.9%，p < 0.05，RR = 14；95%置信区间[CI] 1.91 - 103）。仅在丙泊酚组中观察到OLV期间SjO₂<50%的发生率显著增加（从7.7%增至26.9%，p < 0.05，RR = 3.5；95% CI 1.29 - 12.4）。
与七氟醚麻醉相比，丙泊酚麻醉下OLV期间脑氧饱和度降低的情况更常见。与丙泊酚相比，七氟醚麻醉下肺手术OLV期间的脑氧平衡受损程度较轻；然而，临床结局或对认知功能的影响尚需确定。
