单肺通气对血液七氟醚及地氟醚浓度的影响
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Effect of One-Lung Ventilation on Blood Sevoflurane and Desflurane Concentrations
背景与目的
确定单肺通气（OLV）时血液七氟醚和地氟醚的浓度变化情况。
方 法
本试验为随机、单盲研究。纳入24名35至70岁行腹部手术或开胸手术的患者，分为以下4组：七氟醚TLV组（双肺通气），七氟醚OLV组（单肺通气），地氟醚TLV组和地氟醚OLV组。蒸发器设定为1.5％七氟醚或6％地氟醚。在TLV开始后40分钟以10分钟的间隔（T1-T9）采集血样用于血气分析和气相色谱。在OLV组中，在TLV的40分钟时（T1）收集第一个样品，并且从OLV的开始以10分钟的间隔（T2-T9）收集样品。记录血氧饱和度（SpO2），血流动力学及吸入和呼气末浓度。在相同时间点计算每个患者的麻醉药的摄入分数（F）。
结 果
T3时，七氟醚OLV组七氟醚浓度从40.7±4.4降至30.2±2.5μg/ mL（p = 0.014，降低26％）；地氟醚OLV组，T3时地氟醚浓度从224.6±44.8降至159.8±32μg/ mL（p = 0.018，下降29％）；然而，与T3时地氟醚相比，七氟醚浓度的降低无统计学意义（p = 0.31）。此外，在OLV开始时，麻醉药的摄入分数显著增加（p = 0.001）。
结 论
OLV均可使七氟醚及地氟醚的血液浓度降低。这种情况可能为通气-灌注不当造成。
原始文献摘要
Ebru B , Feride K , Güne? Yasemin, et al. Effect of One-Lung Ventilation on Blood Sevoflurane and Desflurane Concentrations[J]. Journal of Car-diothoracic and Vascular Anesthesia, 2018:S1053077018303653.
OBJECTIVE To determine the blood sevoflurane and desflurane concentrations during one-lung ventilation (OLV).
DESIGN Randomized, single-blind study.
SETTING Single university hospital.
PARTICIPANTS The study comprised 24 patients, 35 to 70 years old who were scheduled for either a major abdominal surgery or thoracotomy.
INTERVENTIONS The patients were divided into the following 4 groups: sevoflurane two-lung ventilation (TLV), sevoflurane OLV, desflurane TLV, and desflurane OLV. Vaporizers were set at 1.5% sevoflurane or 6% desflurane.
MEASUREMENTS AND MAIN RESULTS 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. The mean arterial sevoflurane concentration in the sevoflurane OLV group at T1 decreased from 40.7 ± 4.4 to 30.2 ± 2.5 µg/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 ± 32 µg/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).
CONCLUSION An OLV procedure causes a decrease in the both arterial and venous blood concentrations of sevoflurane and desflurane. This reduction is believed to be due to ventilation-perfusion mismatch.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：符校魁 编辑：何幼芹 审校：王贵龙