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为了了解开胸手术中PaCO_2-P_(ET)CO_2差值的变化及影响因素,观察了43例胸科手术病人,其中肺肿瘤23例、食道贲门肿瘤20例,全部为ASAⅠ～Ⅲ级患者。常规静脉诱导,吸入异氟烷维持麻醉。术中间断给予芬太尼、卡肌宁。分别于麻醉及术中的5个时间点抽取动脉血测定PaCO_2,同时测定P_(ET)CO_2及HR、BP等。结果发现:1.43例开胸前其PaCO_2-P_(ET)CO_2均值都在0.3～0.8kPa之间。2.开胸后10min食道手术患者PaCO_2-P_(ET)CO_2升高有非常显著意义(P<0.01),其余各相邻值间差别无显著性(P>0.05)。3.肺肿瘤患者术中PaCO_2-P_(ET)CO_2在开胸后1小时其PaCO_2-P_(ET)CO_2非常显著升高(P<0.01),其余各相邻值间未见明显变化(P>0.05)。结果表明:开胸手术中,在血压、心率、体位及胸腔负压变化、通气等条件相对稳定时,手术操作刺激对肺通气、血流及其比值(V/Q),并进而对PaCO_2-P_(ET)CO_2产生明显影响。经过一段时间肺组织可逐步适应这种刺激而建立新的平衡,从而PaCO_2-P_(ET)CO_2未发生进一步明显变化。
In order to understand the changes of PaCO_2-P_(ET)CO_2 difference in thoracotomy and its influencing factors, 43 patients with thoracic surgery were examined, including 23 patients with lung tumor and 20 patients with esophageal cardia tumor, all of whom were ASA I-III patients. Routine intravenous induction, inhaled isoflurane maintenance anesthesia. During the operation, fentanyl and carnitine were given intermittently. Arterial blood was collected at five time points during anesthesia and intraoperatively to determine PaCO 2 , and P_(ET)CO_2, HR, BP, etc. were measured at the same time. The results showed that: 1.43 patients before thoracotomy PaCO_2-P_ (ET) CO_2 average in between 0.3 ~ 0.8kPa. 2. The increase of PaCO_2-P_(ET)CO_2 in esophageal sphincter patients after thoracotomy was very significant (P<0.01), but there was no significant difference between other adjacent values (P>0.05). 3. PaCO_2-P_(ET)CO_2 increased significantly in the patients with lung cancer 1 hour after thoracotomy (P<0.01), but no significant change was observed in other adjacent values (P<0.01). >0.05). The results showed that during thoracotomy, when the blood pressure, heart rate, position and chest pressure changes, ventilation and other conditions are relatively stable, the surgical operation to stimulate lung ventilation, blood flow and its ratio (V/Q), and in turn PaCO_2- P_(ET)CO_2 has a significant effect. After a period of time, the lung tissue can gradually adapt to this stimulus and establish a new balance, so that there is no further significant change in PaCO 2 -P_(ET)CO 2 .