Effects Of TCI Sufentanil And Propofol On Intrapulmonary Shunt During One-lung Ventilation

Objective To observe the effects of sufentanil-propofol and isoflurane on intrapulmonary shunt and the change of pulmonary dynamic compliance(Cdyn) during one-lung ventilation.Methods Twenty ASAâ… orâ…¡patients undergoing radical esophagus cancer with OLV were randomly divided into two groups:the sufentanil and propofol group(group SUF)and the isoflurance group(group ISO),10 cases in each group.In group SUF anesthesia was maintained with TCI of sufentanil and propofol(target effective-volume concentration was set at 0.5ng·ml^-1and 3ug·ml^-1);In group ISO, anesthesia was maintained with insoflurance.ECG,SPO₂,SBP,MAP,DBP,P_ETCO₂ and HR were continuously monitored during anesthesia.Arterial and pulmonary blood gases were analyzed and the plasma concentrations of ET and NO in the arterial and the atrium dextrum were measured 30 min after TLV was started(T₀),and 30,60,90 min after OLV was started(T₁,T₂,T₃).The intrapulmonary shunt fraction (Q_s/Q_t)and Cdyn was calculated at T₀-T₃.Results 1 There were no significant differences in the levels of Q_s/Q_t,PaO₂,Cdyn,NO and ET at T₀ between the two groups(P＞0.05).2 The levels of Q_s/Q_t all increased during OLV(P＜0.05).The levels of Q_s/Q_t at T₁～T₃ in group SUF were lower than that in group ISO(P＜0.05).3 The levels of PaO₂ were significantly decreased during operation(from T₁ to T₃) as compared to baseline values(T₀)between the two groups(P＜0.05),but there no significant difference in PaO₂ at T_2-3between the two groups.4 The levels of Cdyn was significantly decreased during operation(from T₁ to T₃) as compared to baseline values(T₀)between the two groups(P＜0.05),high in SUF group than in ISO group at each interval(T_1-3)(P＜0.05).5 There were no significant difference in NO at T_2-3between the two groups(P＞ 0.05).6 The levels of ET in arterial was significantly high in SUF group than in ISO group at each interval(T_1-3)(P＜0.05).There no significant difference in vein with ET.Conclusion The atelectasis and hypoxic stimulus during OLV can make pulmonary endothelium release ET or inhibit pulmonary elimination of ET,Enflurane can suppress the above process.Compared with isoflurane anesthesia,there is less intrapulmonary shunt and high pulmonary dynamic compliance during OLV under general anesthesia with sufentanil-propofol,but the difference is not significant enough to affect PaO₂.