【摘要】 目的 探讨瑞芬太尼全麻与硬膜外阻滞复合全麻对开胸手术单肺通气期间肺内分流和氧合的影响。方法 择期开胸手术患者30例，随机分为两组：硬膜外复合全麻组(Ⅰ组 n=15)和瑞芬太尼全麻组(Ⅱ组 n=15)。两组患者分别于麻醉前，双肺通气20min，单肺通气20、30min时，采集动脉血和静脉血进行血气分析，并计算Qs/Qt。结果 两组患者在单肺通气时，Qs/Qt均较双肺通气时增加显著(P<0.01)。PaO2显著降低(P<0.01)。但两组在单肺通气时比较差异无显著性(P>0.01)。结论 瑞芬太尼全麻与硬膜外复合全麻均对开胸手术单肺通气期间肺内分流和氧合的影响不大，可安全应用。

     【关键词】 瑞芬太尼； 硬膜外阻滞； 单肺通气； 氧合； 肺内分流

    【Abstract】 Objective To compare the effects of remifentanyl and epidural block on oxygenation and pulmonary shunt fraction during one-lung ventilation for thoracotomy. Methods Thirty patients undergoing elective thoracic surgery were randomly divided into two groups: epidural block combined general anesthesia (groupⅠ n=15) and general anesthesia with remifentanyl (groupⅡ n=15). In both groups arterial and venous blood gas analysis were recorded and Qs/Qt was calculated before anesthesia, 20min after TLV, 20,30min after OLV respectively. Results During OLV Qs/Qt in both groups was increased and PaO2 decreased significantly(P<0.01) compared with those during TLV. But there was no significantly differences in Qs/Qt and PaO2 between two groups.Conclusion Both groups of general anesthesia with remifentanyl and epidural block combined general anesthesia are suitable for analgesia during thoracic surgery when OLV is used. ......