异氟烷、七氟烷和地氟烷麻醉期间的呼吸阻力：一项随机临床试验。

Respiratory resistance during anaesthesia with isoflurane, sevoflurane, and desflurane: a randomized clinical trial.

机构信息

Department of Anaesthesiology, University Hospital of Heraklion, Heraklion, Greece.

出版信息

Br J Anaesth. 2011 Sep;107(3):454-61. doi: 10.1093/bja/aer155. Epub 2011 Jun 10.

DOI:10.1093/bja/aer155

PMID:21665899

Abstract

BACKGROUND

To investigate whether the effects of desflurane on inspiratory resistance are similar to those of isoflurane and sevoflurane during 30 min administration at 1 and 1.5 MAC in patients with healthy lungs.

METHODS

Seventy-one patients undergoing elective surgery were randomly assigned to receive isoflurane, sevoflurane, or desflurane. Baseline inspiratory resistance was obtained after intubation and establishment of volume control ventilation. Anaesthesia was maintained with desflurane, isoflurane, or sevoflurane at 1 MAC for 30 min followed by 1.5 MAC for another 30 min. Tidal volume, flow, and inspiratory pressures were continuously recorded with a pneumotachograph. Total inspiratory resistance (R(rs)), minimal resistance (R(min)), and effective resistance (D(Rrs)) were calculated every 5 min using the end-inspiratory occlusion technique.

RESULTS

No significant differences of the evaluated parameters (R(rs), R(min) and D(Rrs)) were observed during administration of the three agents at 1 MAC for 30 min. At 1.5 MAC, desflurane caused a maximum increase in R(rs) by 26% and in R(min) by 30% above baseline, in contrast to isoflurane and sevoflurane which did not display a significant effect on R(rs) (+3.7% by isoflurane and +7.6% by sevoflurane) and R(min) (+4.7% by isoflurane and +9.6% by sevoflurane). All parameters returned to baseline after discontinuation of the volatile agent.

CONCLUSIONS

In healthy adults, neither sevoflurane nor isoflurane produced bronchodilation at 1 and 1.5 MAC. Desflurane did not affect respiratory resistance at 1 MAC, but at 1.5 MAC caused significant increase in both total and airway resistance with return to near baseline values after discontinuation of the agent.

摘要

背景

在健康肺患者中，比较 1MAC 和 1.5MAC 下 30 分钟输注时，地氟醚对吸气阻力的影响是否与异氟醚和七氟醚相似。

方法

71 例行择期手术的患者被随机分配接受异氟醚、七氟醚或地氟醚。插管和容量控制通气建立后，获得基础吸气阻力。30 分钟内以 1MAC 维持地氟醚、异氟醚或七氟醚麻醉，然后再以 1.5MAC 维持 30 分钟。用呼吸气体流量仪连续记录潮气量、流量和吸气压力。在吸气末阻断技术的基础上，每 5 分钟计算总吸气阻力（R(rs)）、最小阻力（R(min)）和有效阻力（D(Rrs)）。

结果

在 1MAC 下输注三种药物 30 分钟期间，各评估参数（R(rs)、R(min)和 D(Rrs)）无显著差异。在 1.5MAC 时，地氟醚引起的 R(rs)最大增加值比基础值高 26%，R(min)增加值比基础值高 30%，而异氟醚和七氟醚对 R(rs)（异氟醚增加 3.7%，七氟醚增加 7.6%）和 R(min)（异氟醚增加 4.7%，七氟醚增加 9.6%）均无显著影响。所有参数在停止挥发性药物后均恢复至基线。