摘要
目的探讨单肺通气(OLV)期间不同吸入氧浓度(FiO_(2))对胸外科手术患者呼吸功能的影响。方法选择2020年11月至2021年8月择期行肺叶切除术的患者57例,男40例,女17例,年龄18~64岁,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级。将患者随机分为三组:FiO_(2)45%组(L组)、FiO_(2)65%组(M组)和FiO_(2)85%组(H组),每组19例。三组分别在OLV期间予以对应的FiO_(2)。记录术前肺通气功能检查指标,包括用力肺活量(FVC)、第1秒用力呼气量(FEV_(1))、1秒率(FEV_(1)/FVC)、分钟最大通气量占预计值百分比(MVV%)。于OLV前5 min、OLV后10、20、30、60 min分别经桡动脉与右颈内静脉抽取动静脉血行血气分析,记录SaO_(2)、PaO_(2)、PaCO_(2)、Hb、Lac,并计算氧合指数(PaO_(2)/FiO_(2))、肺内分流率(Qs/Qt)、死腔率(V_(D)/V_(T)),记录以上各时点肺动态顺应性(Cdyn)、气道峰压(Ppeak)、HR和MAP。结果三组术前FVC、FEV_(1)、FEV_(1)/FVC、MVV%差异无统计学意义。OLV后10、20、30 min M组和H组PaO_(2)明显高于L组(P<0.05)。OLV后10、20、30、60 min M组和H组PaO_(2)/FiO_(2)、Cdyn明显低于L组(P<0.05);H组PaO_(2)/FiO_(2)、Cdyn明显低于M组(P<0.05),Qs/Qt、Ppeak明显高于L组和M组(P<0.05)。OLV后60 min M组Qs/Qt明显高于L组(P<0.05),H组PaO_(2)明显高于L组(P<0.05)。OLV前5 min、OLV后10、20、30、60 min三组SaO_(2)、PaO_(2)、Hb、Lac、HR、MAP差异无统计学意义。结论OLV期间使用FiO_(2)45%和FiO_(2)65%均可以减少肺内分流,提高肺顺应性,改善氧合。
Objective To investigate the effect of different inspired oxygen fraction during one-lung ventilation(OLV) on respiratory function in patients undergoing thoracic surgery. Methods Fifty-seven patients, 40 males and 17 females, aged 18-64 years, BMI 18-28 kg/m^(2), ASA physical status Ⅰ or Ⅱ, scheduled for lobectomy from November 2020 to August 2021 were selected. All the patients were randomly divided into three groups: FiO_(2)45% group(group L), FiO_(2)65% group(group M), and FiO_(2)85% group(group H), 19 patients in each group. Corresponding FiO_(2)was given to the three groups during OLV. Forced vital capacity(FVC), forced expirtory volume in the first second(FEV_(1)), FEV_(1)/FVC, percentage of the maximum ventilation per minute to the estimated value(MVV%) were recorded before the operation. Arterial and venous blood samples were taken from transradial artery and right internal jugular vein 5 minutes before OLV, 10, 20, 30, and 60 minutes after OLV for blood gas analysis, SaO_(2), PaO_(2), PaCO_(2), Hb, and Lac were recorded at each time point;and oxygenation index(PaO_(2)/FiO_(2)), intrapulmonary shunt rate(Qs/Qt), and dead space rate(V_(D)/V_(T)) were calculated at each time point. Pulmonary dynamic compliance(Cdyn), peak airway pressure(Ppeak), HR, and MAP were recorded at each time point. ResultsThere were no significant differences in preoperative FVC, FEV_(1), FEV_(1)/FVC, and MVV% pred among the three groups. Compared with group L, PaO_(2)in groups M and H were significantly increased 10, 20, and 30 minutes after OLV(P < 0.05), PaO_(2)/FiO_(2)and Cdyn in groups M and H were significantly decreased 10, 20, 30, and 60 minutes after OLV(P < 0.05), Qs/Qt and Ppeak in group H were significantly increased 10, 20, 30, and 60 minutes after OLV(P < 0.05), Qs/Qt in group M and PaO_(2)in group H were significantly increased 60 minutes after OLV(P < 0.05). Compared with group M, PaO_(2)/FiO_(2)and Cdyn were significantly decreased, Qs/Qt and Ppeak were significantly increased in group H 10, 20, 30, and 60 min
作者
白颖
马艳巍
李亚星
高晓宁
孙艳斌
BAI Ying;MA Yanwei;LI Yaxing;GAO Xiaoning;SUN Yanbin(Chengde Medical School,Chengde 067000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2022年第6期581-586,共6页
Journal of Clinical Anesthesiology
基金
河北省卫生健康委医学科学研究课题计划(20160305)。
关键词
吸入氧浓度
单肺通气
肺内分流
氧合
Inspired oxygen fraction
One-lung ventilation
Intrapulmonary shunt
Oxygenation
