摘要
目的探讨单肺通气前低氧预处理(HPC)对肺叶切除术患者氧合的影响。方法选取在本院择期行肺叶切除术患者58例,按随机数字表法分为处理组和对照组,每组29例。麻醉诱导插管对位后在行单肺通气(OLV)前,处理组缺氧使脉搏血氧饱和度(SpO2)降至0.90,随即复氧使SpO2回升至1.00后持续通气3 min,重复2次,每次SpO2为0.90时进行动脉血气分析,并记录SpO2由1.00降至0.90的缺氧耐受时间。对照组实施常规通气。2组均在麻醉前(T)、OLV前(T0)、OLV 30 min(T1)、OLV 60 min(T2)、OLV 90 min(T3)抽取桡动脉及颈内静脉血测血气并计算肺内分流率(Qs/Qt),同时在T0、T1、T2、T3时刻检测血小板计数(PLT)及平均血小板体积(MPV)。记录OLV时间、术中各时刻的生命体征及气道压(Peak)。结果2组OLV各时点平均动脉压(MAP)、SpO2、心率(HR)、Peak、动脉血二氧化碳分压[p(CO2)]、pH、血红蛋白(Hb)、动脉血氧饱和度(SaO2)差异无统计学意义(P>0.05)。在2次HPC过程中,缺氧耐受时间由(6.9±1.3)min延长至(7.9±1.1)min(P<0.05),未观察到严重不良反应。OLV后2组动脉血氧分压[p(O2)]水平较OLV前明显下降,但对照组各时间点p(O2)较处理组下降更明显,OLV后2组Qs/Qt较OLV前升高,对照组各时间点Qs/Qt较处理组升高更明显(P<0.05或P<0.01)。2组PLT、MPV差异无统计学意义(P>0.05)。结论单肺通气前对患者行低氧预处理是安全的,可以降低患者OLV期间肺内分流率、提高氧分压、改善肺叶切除术患者的氧合,其作用与血小板计数及功能的关系不明确。
Objective To investigate the effect of hypoxic preconditioning(HPC)before single-lung ventilation on oxygenation in patients with pulmonary lobectomy.Methods Fifty-eight patients who underwent elective lobectomy in our hospital were selected in this study.Patients were divided into treatment group(group P)and control group(group N)according to the random number table,with 29 cases in each group.After anesthesia-induced intubation and before onelung ventilation(OLV),hypoxia was used to reduce SpO2 to 0.90 in group P,and then reoxygenation was used to increase SpO2 to 1.00.The ventilation was continued for 3 minutes,and repeated twice.The arterial blood,gas was measured at the end of each treatment,and the hypoxia tolerance time of SpO2 from 1.00 to 0.90 was recorded.Group N was subjected to routine ventilation.Radial arterial and internal jugular vein blood were taken for blood,gas and intrapulmonary shunt rate(Qs/Qt)was measured before and after OLV(T0),OLV 30 min(T1),OLV 60 min(T2)and OLV 90 min(T3).Platelet(PLT)and mean platelet volume(MPV)were measured at T0,T1,T2 and T3.The OLV time,vital signs at each time point during the operation and peak airway pressure(Peak)were also recorded.Results There were no significant differences in OLV time,the average arterial pressure(MAP),SpO2,heart rate(HR),Peak,p(CO2),pH,hemoglobin(Hb)and arterial blood oxygen saturation(SaO2)during operation between the two groups(P>0.05).During the two HPC sessions,the hypoxia tolerance time was extended from(6.9±1.3)min to(7.9±1.1)min(P<0.05),and no serious adverse reactions were observed.After OLV,the levels of p(O2)were significantly lower in the two groups than before OLV,but the levels of p(O2)were significantly lower at each time point in the group N than that in the group P(P<0.05).After OLV,the Qs/Qt values were significantly higher than those before OLV in the two groups,and the Qs/Qt of each time point was higher in the group N than that of the group P(P<0.05).There were no significant differences in PLT and MPV between the t
作者
阳倩
刘丹彦
YANG Qian;LIU Dan-yan(Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)
出处
《天津医药》
CAS
北大核心
2020年第9期866-870,共5页
Tianjin Medical Journal
关键词
单肺通气
肺切除术
低氧
低氧预处理
氧合
one-lung ventilation
pneumonectomy
hypoxia
hypoxic preconditioning
oxygenation
