目的 探讨异丙酚和七氟醚对肺结核患者单肺通气肺内分流和氧合的影响.方法 选择因肺结核病变择期行胸腔镜手术患者40例,美国麻醉医师学会分级(ASA)Ⅰ~tⅡ 级,随机分为两组:异丙酚TCI组(P组)和七氟醚吸入组(S组),分别于双肺通气后15min(T1)、单肺通气后5min(T2)、15min(T3)、30min(T4)、60min(T5)记录平均动脉压(MAP)、HR、SpO2,并采集动脉血和右心房血行血气分析,计算肺内分流率和氧合指数,记录术后并发症发生情况.结果 两组间MAP、HR、SpO2差异不显著(P>0.05),单肺通气时P组和S组T2、T3、T4、T5时间点与双肺通气T1时间点比较,氧合指数显著降低(P<0.01),肺内分流率显著增加(P<0.01);P组和S组比较,氧合指数各时间点差异不显著(P>0.05),但肺内分流率S组T3、T4点显著增加(P<0.05);S组术后并发症高于P组(P<0.05).结论 异丙酚TCI可安全有效的应用于肺结核患者胸腔镜手术麻醉,且在单肺通气后15min、30min减轻肺内分流,减少术后并发症发生.%Objective To investigate the effects of propofol and sevoflurane anaesthesia on intrapulmonary shunt and arterial oxygenation of pulmonary tuberculosis patients with one-lung ventilation. Methods Forty pulmonary tuberculosis patients with ASA Ⅰ- Ⅱ level pulmonary tuberculosis scheduled for a lobectomy were randomly divided into two groups (propofol group and sevoflurane group).The arterial blood of patients was sampled at 15mins (T1) before one-lung ventilation,5mins (T2),15mins (T3),30mins (T4),and 60mins(T5) after one-lung ventilation,the arterial oxygenation and other hemodynamic parameters were determined. Simultaneously,the associated clinical data were also recorded. Results The mean PaO2 of patients from propofol group and sevoflurane group at T2,T3,T4 and T5 were significantly lower than that from T1 (P<0.01). The intrapulmonary shunt ratio was significantly increased after one-long ventilation (P<0.01). The mean PaO2 of patients from propofol group were not significantly different from that from sevoflurane group at various time points(P>0.05). However,the intrapulmonary shunt ratio of patients from propofol group were significantly increased compared with that from sevoflurane group at T3、T4(P<0.05). Conclusions Propofol anaesthesia for patients with pulmonary tuberculosis undergoing lobectomy can decrease the intrapulmonary shunt at some time points during one-long ventilation compared with sevoflurane anaesthesia.
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