摘要
目的观察选择性肺叶隔离通气和单肺通气对胸科手术患者肺内分流的影响。方法择期行下段食管癌或贲门癌根治术患者60例,采用随机数字表法分为单肺通气组(OLV组)和选择性肺叶隔离通气组(SLC组)。OLV组患者采用支气管封堵器实施左肺隔离行右肺单肺通气;SLC组患者实施左下肺叶隔离行右肺+左上肺叶通气。于平卧位双肺通气10分钟(T_0)、侧卧位双肺通气后10分钟(T_1)、单肺通气或选择性肺叶隔离通气10分钟(T_2)和术毕双肺通气10分钟(T_3)4个时点取桡动脉血和中心静脉血,进行血气分析,计算肺内分流率(Qs/Qt)。结果与T_0时比较,两组患者在T_1、T_2、T_3时的Pa O_2均明显降低(P<0.05),SLC组T_2时Pa O_2明显高于OLV组(t=-7.376,P=0.000);与T_0时比较,两组患者在T_1、T_2、T_3时的Qs/Qt均明显升高,SLC组在T_2、T_3时Qs/Qt均明显低于OLV组(t=8.766,P=0.000;t=2.375,P=0.000)。结论选择性肺叶隔离通气适用于下段食管癌或贲门癌根治术的通气管理,能明显减少单肺通气时的肺内分流,提高单肺通气时氧分压。
Objective To evaluate the effects ofpulmonary hunt during ventilation with selectivelobar collapse and one-lung ventilation inthoracic surgery. Methods A total of 60 patients with low esophageal carcinomaorcardial carcinoma were randomlyassigned into 2 groups：patientsin one lung ventilation （OLV）group received right lung ventilation and left lung collapses,patients in selective lobar collapse （SLC）group received rightlung and superior lobe of left lung ventilation by the use of endobronchial blocker.The blood samples were obtained from the jugular venous and radialartery for blood gases analysis, and then calculated the intrapulmonary shunt fraction （Qs/Qt）at four time points： 10 min after two lung ventilation insupine position（T0）, 10 min after two lung ventilation in lateral position（T1）,30 min after OLV or SLC in lateral position（T2）,10 min two lung ventilationafter surgery （T3）. Results Compared to T0, the PaO2 was significantly lower at T1-T3 in the two groups （P〈0.05）. AtT2, the PaO2 in SLC groupwas significantly higher than OLV group（t=-7.376, P=0.000）.Compared withT0 , Qs/Qt atT1-T3 were significantly higher in both groups（t=8.766, P=0.000）.AtT2-T3,Qs/Qt were lower in SLV group than OLV group（t=2.375, P=0.000）. Conclusion SLC technologycould significantly reduce thepulmonary shunt during one lung ventilation and improve the PaO2 during one lung ventilationin patients undergoing Surgeries to treat low Esophagealor Cardial Carcinoma.
作者
赵栋
吕华燕
徐军
杨娜
乐新会
蓝志坚
ZHAO Dong;LV Huayan;XU Jun(Jinhua Central Hospital,Zhejiang 321000,China)
出处
《浙江创伤外科》
2018年第5期864-866,共3页
Zhejiang Journal of Traumatic Surgery
基金
浙江省金华市科学技术研究计划项目重点项目(2014-3-13)
关键词
支气管封堵
单肺通气
肺叶隔离
肺内分流
Bronchial occlusion
One lung ventilation
Selective lobar collapse
Pulmonary shunt
