摘要
目的研究单肺通气(OLV)行胸科微创手术中非通气侧肺高频喷射通气(HFJV)的作用。方法达芬奇机器人胸腺瘤切除术患者30例、电视胸腔镜胸腺瘤切除术40例,各随机分为2组,每组35例,全麻快速诱导后插入左侧双腔支气管导管,A组左肺单肺通气后右肺行高频喷射通气(HFJV),HFJV频率60次/min,驱动压0.5kg/cm2;B组行左肺单肺通气。分别于OLV前(T1)及OLV后10min(T2)、30min(T3)、60min(T4)、术毕恢复双肺通气后10min(T5)行血气分析,计算肺内分流(Qs/Qt),同时监测气道压力并计算肺顺应性(Cdyn)。结果与T1时比较,T2-T4时两组PaO2均下降,Qs/Qt、气道峰压(Pmax)升高、肺顺应性下降(P<0.05);与B组比较,A组T2-T4时PaO2高于B组、Qs/Qt低于B组(P<0.05),气道峰压(Pmax)、肺顺应性较B组无明显差异。结论高频喷射通气辅助单肺通气可使胸腺瘤微创手术患者降低肺内分流,维持较好的PaO2。
Objective To study the role of high frequency ejection ventilation（HFJV）-assisted one lung ventilation（OLV） in minimally invasive thymectomy.Methods Thirty patients undergoing thymectomy with da Vinci STM surgical system and forty patients undergoing thymectomy with VATS were randomly divided into group A and group B（35 in each group）.After anesthesia,a left-sided double-lumen endotracheal tube was inserted.Patients in group A underwent HFJV for the right lung after OLV（f=60bpm,driving pressure=0.5kg/cm2）.Patients in group B received left-lung ventilation during operation.Blood gas was analyzed,Qs/Qt and lung compliance（Cdyn） were measured before OLV（T1）,10 min（T2）,30 min（T3）,60min after OLV（T4）,and 10min after double lung ventilation（T5）,respectively.Results The PaO2 and Cdyn were lower while the Qs/Qt and Pmax were higher at T1 than at T2-T4 in both groups（P0.05）.The PaO2 was higher while the Qs/Qt was lower in group A than in group B（P0.05）.No significant difference was found in Cdyn and Pmax between the two groups.Conclusion HFJV-assisted OLV can decrease the Qs/Qt and maintain a higher PaO2 in patients undergoing minimally invasive thymectomy.
出处
《军医进修学院学报》
CAS
2012年第4期348-349,356,共3页
Academic Journal of Pla Postgraduate Medical School
关键词
单肺通气
达芬奇手术机器人
胸腺瘤
高频通气
电视胸腔镜
one lung ventilation
da Vinci STM surgical system
thymoma
high frequency ventilation
video-assisted thoracoscopic surgery
