摘要
目的比较不同通气模式在老年患者胸科手术单肺通气(OLV)期间对气道压力及氧合情况的影响。方法分析本院于2016年10月-2017年8月行胸科手术需单肺通气的110例老年患者,将其随机分成两组,容量控制通气组和压力控制通气+呼气末正压(PCV+PEEP)组,在实施全身麻醉双腔管插管后,给予双肺通气,开胸后分别实施不同的通气模式给予单肺通气,将行容量控制通气模式(VCV)的53例患者作为对照组,压力控制通气模式(PCV)+呼气末正压通气(PEEP)模式的57例患者作为观察组,比较两组在单肺通气开始前(t _0)、单肺通气30 min(t _1)、60 min(t _2)、以及OLV结束时(t _3)四个不同时间点的气道压力、肺顺应性以及氧合情况。结果两组在单肺通气开始前t _0,其Ppeak、Pplat、Cdynh和PCO _2、氧合指数OI组间差异无统计学意义(P_>0.05);t _1、t _2、t _3的气道压力和氧合指标对比,观察组气道峰压和动脉血二氧化碳分压、氧合指数均较对照组优(P_<0.05),两组气道平台压Pplat未见明显异常(P_>0.05)。结论老年患者于胸科手术单肺通气期间行小潮气量PCV+PEEP通气模式可有效降低气道压力,改善肺通气和氧合。
Objective To compare the effects of different ventilation modes on airway pressure and oxygenation during lung ventilation（ OLV） during thoracic surgery in elderly patients. Methods The clinical data of 110 elderly patients who had received thoracic surgery in our hospital fromOctober 2016 to August 2017 were analyzed, and according to the random number table method, these patients were divided into two groups： volume-controlled group, and pressure-controlled ventilation plus positive end-expiratory pressure（PCV＋PEEP） group. The 53 cases given volume-controlled ventilation were taken as the control group, and the 57 cases given pressure-controlled ventilation（PCV）plus positive end-expiratory pressure（PEEP）were taken as the observation group. The airway pressure, lung compliance and oxygenation before one-lung ventilation（t0）,after ventilation or 30 minutes（t1）and for 60 minutes（t2）,as well as at the end ofOLV（t3）were compared. Results The Ppeak, Pplat, Cdynh, PCO2 and OI at t0 in two groups showed no statistically significant difference（P〉0.05）;The airway pressure and OI at t1, t2 and t3, the Ppeak, PaCO2 and OI in the observation group were all shown to be better than those in the control group（P〈0.05）.However, the Pplat showed no significant difference between two groups（P〉0.05）.Conclusion For elderly patients undergoing thoracic surgery, low tidal volume of PCV plus PEEP during the one-lung ventilation can effectively reduce airway pressure and improve the lung ventilation and oxygenation.
作者
朱叶苇
阿布力克木.艾买提
ZHU Yewei;Abulikemu·Amati(Department of Anesthesiology,the first affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830011,China)
出处
《新疆医学》
2018年第7期723-725,729,共4页
Xinjiang Medical Journal
关键词
胸科手术
老年
单肺通气
通气模式
Thoracic Surgery
Elderly
One-Lung Ventilation
Ventilation Mode
