Objective To study the effects of thoracic epidural anesthesia(TEA) with bupivacaine on oxygenation, shunt fraction during one-lung ventilation( OLV) . Methods Sixty patients who had prolonged periods of OLV for elective thoracic surgery for esophageal cancer were randomized into two groups. Thirty patients ( group A) were anesthetized with propofol/atracurium/epidural thoracic bupivacaine 0?5%. In another 30 patients ( group B) , fentanyl/propofol/atracurium anesthesia was used. A double-lumen en-dotracheal tube was inserted, and mechanical ventilation with 100% oxygen was used during the entire study. Arterial and venous blood gases were recorded before surgery in a lateral position with two-lung ventilation, 15 and 30 min after OLV ( OLV+15 and OLV+30, respectively) in all patients. PaO2, venous central oxygen tension, arterial and central venous oxygen saturation, venous admixture per-centage (Qs/Qt) were measured. Results The mean values for PaO2 during OLV in the group A after 15min with (219?3±48?2)mm-Hg and 30min with ( 174?7 ± 37?6 ) mmHg were significantly lower compared with the group B ( 268?1 ± 81?2mmHg and 221?6 ± 87?0mmHg, respectively) . Furthermore, Qs/Qt was significantly increased in group A during OLV. And, blood pressure was signifi-cantly lower in group A during surgery. There were no significant differences. Conclusion We conclude that using the TEA regimen is associated with a lower PaO2 and a larger intrapulmonary shunt during OLV than with total anesthesia alone.

Objective To compare the effects of dezocine combined with flurbiprofen axetil or tramadol in the postoperative analgesia of patients treated with thorascopic surgery. Methods Sixty patients scheduled for video-as-sisted thoracoscopic surgery were randomly divided into 2 groups. All the patients received an intravenous load dose of dezocine 0. 1-0. 15 mg·kg-1 and tropisetron 6 mg in the 30 min after surgery. Patient controlled analgesia pump (2 mL·h-1 )was performed in all the patients. The formula of patient controlled analgesia in the group A was dezocine 0. 5 mg·kg-1 combined with flurbiprofen axetil 3 mg·kg-1 and tropisetron 6 mg;that of the B group was dezocine 0. 5 mg·kg-1 combined with tramadol 10 mg·kg-1 . VAS scores were recorded in the 2,4,12,24 and 48 h after the surgery. Automatic frequency and toxicities of patient controlled analgesia were also recorded in the 48 h after the surgery. Results All the patients of the two groups got favourable analgesia. No significant difference was observed between the two groups in the VAS scores at all the observed points and the automatic frequency in the 48 h after the surgery. The nausea and vomiting rate significant higher in the group B was than that in the group A. Conclusion Dezocine combined with flurbiprofen axetil is safe and effect in the postoperative analgesia of patients treated with thorascopic surgery.

目的 观察不同浓度布比卡因胸段硬膜外阻滞对单肺通气(OLV)期间动脉氧合的影响.方法 择期行经左胸食管癌根治术患者120例,年龄50～65岁,随机数字表法均分为四组:A、B、C组采用静脉全麻复合硬膜外阻滞,硬膜外分别给予0.5％、0.25％、0.125％布比卡因,D组为单纯静脉全麻,每组30例.A、B、C三组患者诱导前硬膜外注入5 ml相应浓度布比卡因,术中以3～5ml/h持续硬膜外泵入.分别于OLV前(T0)、OLV 15 min(T1)、OLV 30 min(T2)抽取桡动脉血和混合静脉血行血气分析.结果 T1、T2时A组Qs/Qt明显高于其他三组(P＜0.05),PaO2明显低于其他三组(P＜0.05).T0～～T2时A、B组SBP、DBP均明显低于D组(P＜0.05).与D组比较,A、B、C组术中阿片类药物和丙泊酚的用量均明显减少(P＜0.05).结论 静脉全麻复合0.125％和0.25％布比卡因胸段硬膜外阻滞在OLV期间不会增加肺内分流和降低动脉氧合.

OBJECTIVE:To explore the effects of ketamine inhalation before one-lung ventilation (OLV) in patients undergoing transthoracic esophagectomy for esophageal cancer.METHODS:Upon the approval of hospital ethic committee, 90 American Society of Anesthesiologists grade I-II patients scheduled for elective trans-left-thoracic esophagectomy for esophageal cancer were randomly and single-blindly divided into 3 groups. After intravenous anesthesia with double-lumen endobronchial intubation, the patients in each group received different therapies before OLV, i.e. inhaling ketamine 1 mg/kg in Group Ki, intravenous infusion of ketamine 1 mg/kg in Group Kv and inhaling normal saline 10 ml in Group C. Arterial blood gas analysis was performed. And (oxygen saturation) SpO2, (partial pressure of end-tidal carbon dioxide) PETCO2, (airway pressure) Paw and hemodynamic indicators were recorded at these points:before OLV (T1), OLV for 30 min (T2), OLV for 1 h (T3), OLV for 2 h (T4), OLV ended 5 min (T5) and end of surgery (T6). Central venous blood was sampled at T1, T2 and 2 h after surgery (T7) for the determination of interleukin-6 (IL-6), interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations by enzyme-linked immunosorbent assay (ELISA).RESULTS:Serum levels of IL-6, IL-8 and sICAM-1 in all groups increased significantly than those at previous timepoints. Serum levels of IL-6, IL-8 and sICAM-1 in Groups Ki and Kv were significantly lower than those in Group C at T7. PaO2 in Groups Ki and Kv was significantly higher than that in Group C at T4. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in Group Kv were significantly higher than that in Groups Ki and C at T2-T4; HR in Group Kv was significantly higher than that in Group C at T2-T3. Paw in Group Kv was significantly higher than that in Group C at T2-T6.CONCLUSION:Inhalation and intravenous infusion of ketamine before OLV are equally effective in lowering the serum levels of IL-6, IL-8 and sICAM-1. And ultrasonic atomizing inhalation of ketamine can avoid adverse effects on airway pressure and circulatory system caused by an intravenous infusion of ketamine.

目的探讨肺功能减退肺癌患者施行全肺切除手术的围麻醉期管理经验。方法回顾性分析23例肺功能减退患者行全肺切除手术在围麻醉期的管理,行右全肺切除者10例,左全肺切除者13例。结果所有患者无一例围麻醉期死亡。结论全面衡量患者情况,积极治疗影响肺功能的疾患。术前进行必要的呼吸功能锻炼,术中适当的麻醉处理和术后全面监护、合理的机械通气,可以减少或避免并发症的发生,使患者安全渡过围麻醉期。

观察碳酸利多卡因在实施高位硬膜外阻滞时的可行性和效能,及其对患者呼吸循环的影响和不良反应.择期乳腺癌根治术患者56例,随机分为两组,A组(对照组),用1%盐酸利多卡因,pH4.58.B组(实验组),用1%碳酸利多卡因,pH6.92.于T2～3或T3～4正中入路行硬膜外穿刺,向头端置管3 cm.观察麻醉起效时间、维持时间,记录麻醉前后左右心率、血氧饱和度、血压及潮气量、呼吸频率的变化.两组起效时间及阻滞完善时间,B组明显较A组短(P＜0.05).麻醉维持时间及阻滞范围则相差无几.两组与麻醉前相比,血压、心率及潮气量均明显下降(P＜0.05),而两组间比较无差异.碳酸利多卡因起效增快,痛觉完全消失时间显著缩短,麻醉效能可靠,可以适用于高位硬膜外阻滞.

目的观察异丙酚和咪唑安定这二种药物用于老年肿瘤病人全麻诱导时的血液动力学的变化.方法40例ASAⅠ～Ⅱ级老年患者随机分成异丙酚组(Ⅰ组)和咪唑安定组(Ⅱ组),分别静注异丙酚2 mg/kg和咪唑安定0.2 mg/kg,入睡后静注芬太尼0.2 mg、氯化琥珀胆碱100mg后气管插管并静注维库溴铵0.1 mg/kg,记录诱导前后的SBP、DBP、MAP、HR等参数.结果插管后5 min时Ⅰ组HR较诱导前明显减慢,Ⅱ组病人无明显变化.诱导后Ⅰ组MAP降幅达27.6%,Ⅱ组MAP降幅为11.1%,两组间有显著差异.结论与异丙酚相比,咪唑安定具有不良反应小、对血流动力学影响轻微等特点,更适合于年老体弱、心功能不全或合并传导功能障碍病人的全麻诱导.

Objective To compare the hymodynamatic effects of anesthetic inductions with propofol(Group Ⅰ, 23 cases) and midazolam (Group Ⅱ,25 cases). Methods Forty-eight patients undergoing thoractic operation were classified randomly into two groups according to intravenous anesthetic agents used:propofol group (propofol 2 mg/kg) and midazolam group (midazolam 0.2 mg/kg).Anesthesia was induced with one of these two drugs followed by endotracheal intubation. The systaltic pressure (SBP),diastolic pressure(DBP), and heart rate (HR) were measured and recorded at following occasions:before induction, after induction,immediately,1,3,5, and 10 minutes after the tracheal intubation.Results After induction, SBP and DBP significantly decreased in both group.Immediatley and 1 minute after the tracheal intubation, SBP and DBP increased in group Ⅱ. Immediately after the intubation, HR also increased. But 5 and 10 minutes after the intubation, HR decreased in both groups. 10 minutes after the intubation, DBP increased in group Ⅰ while SBP still decreased in group Ⅱ.Conclusions Midazolam has a stable and long effect on the cardiovascular function, but could not depress the response of tracheal intubation effectively.And because the impaired cardiovascular function might be further compromised after induction with propofol in patients with cardiovascular disease, it is suggested that propofol be used quite carefully or not be used at all despite the fact that it may depress the response of tracheal intubation more effectively than midazolam.