單肺麻醉時平躺姿勢對動脈血氧之影響

背景：單肺麻醉術（one-lung anesthesia）之應用，主要是用雙腔支氣管內管（double-lumen endobronchial tube）分隔兩肺，除可防止病變肺的感染物或血液進入好的肺，尚可提供不受干擾的手術空間，與清晰的手術視野，過去是採側位下進行，效果良好。近來治療手汗症（hyperhidrosis palmaris）之手術改用平躺（仰位）姿勢，以內視鏡方法進行，亦以單肺換氣輔助手術進行。此種仰位單肺麻醉術中，其血動力學變化及動脈血氧之改變，過去之研究報告，僅限於血氧飽和濃度而無血氧分析之資料，本研究即配合血氧飽和濃度與血氣分析作一探討。方法：我們收集42位接受胸腔鏡交感神經燒灼術的病人，使用雙腔支氣管內管進行全身麻醉，病人於麻醉過程中，分別在雙肺通氣，左及右側單肺通氣時，抽取動脈作血液氣體分析之資料。結果：雙肺通氣（50% N_2O－O_2）五分鐘後之PaO_2值為256±59 mmHg；以左側單肺通氣（100% O_2）五分鐘後，PaO_2值為126±47 mmHg；以右側單肺通氣（100%O_2）五分鐘後，PaO_2值為93 ± 42 mmHg；手術結束後恢復雙肺通氣（100%O_2）五分鐘後，PaO_2值為450±73mmHg。其中右或左單肺通氣之PaO_2值都低於手術前之雙肺通氣PaO_2值（p＜0.05）。右側單肺通氣之PaO_2值也明顯的低於左側單肺通氣之值（p＜0.05）。結論：在無肺部疾病的患者，於平躺姿勢下以純氧吸入行單肺麻醉時，PaO_2值仍然可維持在安全值。

關鍵字

單肺麻醉術；雙腔支氣管內管；手汗症

並列摘要

Background: One-lung ventilation during anesthesia (one-lung anesthesia) in patients under lateral decubitus position to help performing intra-thoracic surgical procedures was well known to have larger alveolar-to-arterial oxygen tension difference and lower arterial oxygen tension (PaO_2) as compared to two-lung ventilation. In the present study, we investigate the changes of arterial oxygen tension in the supine position during one-lung anesthesia. Methods: Forty-two patients of palmar hyperhidrosis, ASA class I-II, scheduled to receive bilateral transthoracic endoscopic sympathectomy were studied. After anesthetic induction (fentanyl, thiopental, and succinylcholine), a 35 (for female) or 37 (for male) French left-sided Robertshaw double-lumen endobronchial tube was intubated. Anesthesia was maintained with isoflurane 1.0-1.5% and 50% O_2-N_2O. They were changed to isoflurane 1.5-2.0% and 100% O_2 during one-lung ventilation. Once the surgical operation is completed, they were changed to 100% O_2 and two-lung ventilation. Arterial blood gases were measured at 4 phases: 5 min after endobronchial intubation (two-lung ventilation), 5 min after left one-lung ventilation, 5 min after right one-lung ventilation, and 5 min after accomplishing operation (two-lung ventilation). Results: The results showed PaO_2 were significantly lower in left and right one-lung ventilation with 100% O_2 as compard with that obtained from two-lung ventilation with 50% O_2 5 min after endobronchial intubation (p ＜ 0.05). Furthermore, right one-lung ventilation had a lower PaO_2 than left one-lung ventilation (p ＜ 0.05). Conclusions: We conclude that arterial oxygen tension can be safely maintained during one-lung anesthesia with pure oxygen in healthy patients lying in a supine position.

並列關鍵字

Anesthesia: one-lung ； Endobronchial tube: double-lumen ； Hyperhidrosis palmaris

國際替代計量

單肺麻醉時平躺姿勢對動脈血氧之影響

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