摘要
目的:观察在开胸手术中单肺通气(OLV)时低潮气量(VT)复合呼气末正压(PEEP)对肺内分流、呼吸力学及血流动力学的影响。方法:选择40例择期行开胸手术的患者,ASA I～Ⅱ级,麻醉诱导后行双腔支气管插管,随机分为两组:常规潮气量组(A组:VT=10mL/kg,呼吸频率12次/min)、低潮气量复合呼气末正压组(B组:VT=6mL/kg,PEEP=0.49kPa,呼吸频率16次/min),每组患者分别在单肺通气前1min(T1)、单肺通气30min(T2)、单肺通气结束前(T3)抽取动脉血和混合静脉血行血气分析并根据结果计算肺内分流率(Os/Ot),同时监测气道峰压(Ppeak)、呼气末二氧化碳分压(PETCO2)、桡动脉压(ABP)及心率(HR)。结果:B组与A组相比,单肺通气后Ppeak明显下降(P<0.05),Os/Ot明显减低(P<0.05);PETCO2、ABP、HR无显著差异。结论:单肺通气时应用低潮气量复合呼气末正压通气可降低气道压,且有利于改善单肺通气时的肺内分流。
Objective：To study the effect of low tidal volume（VT） composite positive end expiratory pressure（PEEP） on intrapulmonary shunt,respiratory mechanism and hemodynamics in open-chest operation during one lung ventilation（OLV）.Methods： Fourty lung cancer patients were selected to execute operation,put into double lumen endobronchial intubation after induction of anesthesia.The patients were randomly divided into groups A（VT=10 mL/kg,f=12/min） and B（VT=6 mL/kg,PEEP=0.49 kPa,f=16 /min）.Intraoperative continuous monitoring PETCO2,Ppeak,ABP and HR,extracting the arterial bloods and mixed venous blood for blood gas analysis before OLV（T1）,OLV after 30 min（T2）,OLV before the end of l min（T3）,and calculated the intrapulmonary shunt ratio（Os/Ot） according to the results.Results： Compared with the conventional ventilation mode,Ppeak of low VT plus PEEP ventilation mode were significantly decreased（P〈0.05） after one lung ventilation,and Os/Ot was significantly reduced（P〈0.05）,PETCO2,ABP and HR had no significant difference.Conclusion： Application of low VT plus PEEP ventilation can decrease airway pressure,which is beneficial to improve lung oxygenation during single lung ventilation.
出处
《广西医科大学学报》
CAS
2012年第2期216-218,共3页
Journal of Guangxi Medical University
基金
2010广西科技厅青年基金资助项目(项目编号:013087)
关键词
单肺通气
潮气量
呼气末正压
肺内分流
one lung-ventilation； tidal volume； positive end expiratory pressure； intrapulmonary shunt
