单肺通气对七氟醚和地氟醚血药浓度的影响
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Effect of One-Lung Ventilation on Blood Sevoflurane and Desflurane Concentrations
背景与目的：本实验旨在探究单肺通气（OLV）过程中七氟醚和地氟醚血药浓度的变化情况。
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方法：本实验采用随机单盲研究。共纳入将实施腹部手术或开胸手术患者24名，年龄在35-70岁之间。将这些患者分为4组：双肺通气（TLV）七氟醚组、单肺通气七氟醚组、双肺通气地氟醚组和单肺通气地氟醚组。将七氟醚和地氟醚的挥发灌分别设置为1.5%和6%。在TLV组中，在通气进行40min后开始抽取血样进行血气分析和气相色谱分析，每间隔10min抽一次血样(T1-T9)。OLV组血样抽取同TLV组。记录SpO2、循环指标、吸入和呼气末挥发物的含量。在相同时间点记录每个患者挥发物的摄取分数。
结果：在OLV七氟醚组，平均动脉七氟醚浓度从T1时刻40.7± 4.4 mg/mL下降到T3时刻30.2 ±2.5 mg/mL(P = 0.014,下降 26%)。在TLV地氟醚组，平均动脉地氟醚的浓度从T1到T3的变化为224.6 ± 44.8 mg/mL到159.8 ± 32mg/mL(P=0.018, 下降29%)。然而，与地氟醚相比，七氟醚浓度在T3时的减少量无统计学意义(P = 0.31)。此外，挥发性药物的摄取分数在OLV开始时显著增加(P = 0.001)。
结论：OLV手术可降低七氟醚和地氟醚的血药浓度。
Biricik E, Karacaer F, Güneş Y,et al. Effect of One-Lung Ventilation on Blood Sevofluraneand Desflurane Concentrations.[J] J. Cardiothorac. Vasc. Anesth. 2018 Jun 01 DOI：10.1053/j.jvca.2018.05.032
BACKGROUND:To determine the blood sevoflurane and desflurane concentrations during one-lung ventilation (OLV).
METHODS:Randomized, single-blind study.Single university hospital.The study comprised 24 patients, 35 to 70 years old who were scheduled for either a major abdominal surgery or thoracotomy.The patients were divided into the following 4 groups: sevoflurane two-lung ventilation (TLV), sevoflurane OLV, desfluraneTLV, and desflurane OLV. Vaporizers were set at 1.5% sevoflurane or 6% desflurane.In the TLV groups, blood samples were taken in 10-minute intervals starting 40 minutes after the start of TLV(T1-T9) for blood gas analysis and gas chromatography. In the OLV groups, the first sample was collected at 40 minutes of TLV (T1), and other samples were collected in 10-minute intervals from the start of OLV (T2-T9). Saturation of peripheral oxygen (SpO2), hemodynamic variables, and inspired and end-tidal volatiles were recorded. The fraction uptake of the volatile agents (F) was calculated for each patient at the same time points.
RESULTS:The mean arterial sevoflurane concentration in the sevoflurane OLV group at T1 decreased from 40.7± 4.4 to 30.2 ±2.5 mg/mL at T3(p = 0.014, 26% decrease). In the OLV desflurane group, the mean arterial desflurane concentration at T1 declined from 224.6± 44.8 to 159.8±32mg/mL at T3 (p=0.018, 29% decrease). However, the reduction of sevoflurane concentration compared with that of desflurane at T3 was not statistically significant (p = 0.31). In addition, the fraction uptake of the volatile agents values significantly increased at the start of OLV (p = 0.001).
CONCLUSIONS:An OLV procedure causes a decrease in the both arterial and venous blood concentrations of sevoflurane and desflurane.
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