【摘要】 目的肺保护性通气策略可降低成人呼吸窘迫综合征(adult respiratory distress syndrome,ARDS)患者的死亡率、改善肺功能,但该策略对开胸手术单肺通气(one lung ventilation,OLV)患者的影响尚在研究中。文中根据双肺通气的准静态肺压力-容量(P-V curve)曲线吸气支的低位拐点对应的压力值(Pinf)设置PEEP,观察不同值PEEP、小潮气量的肺保护性通气方式在开胸手术OLV期间对患者呼吸力学、气体交换功能的影响。方法选择37例择期开胸手术患者,术前肺功能正常或轻度减退、ASA1~2级。随机分为3组:C组(Vt=10 ml/kg、PEEP=0)12例,P0组(Vt=6 ml/kg、PEEP=Pinf+0 cmH2O)12例,P2组(Vt=6 ml/kg、PEEP=Pinf+2 cmH2O)13例。分别于术前双肺通气(two lung ventilation,TLV)、OLV各20 min后作血气分析;分别于侧卧位TLV、开胸后OLV5 min后记录气道平台压(Pplat)、气道阻力(Raw)、肺动态顺应性(Cdyn)。结果与术前比较,3组TLV、OLV时PaO2增加,但TLV时最高(P<0.01),3组OLV、TLV时P(A-a)DO2增加,但OLV最高(P<0.01);在同时点各组间的P(A-a)DO2和PaO2差异无统计学意义(P>0.05)。与TLV比较,3组OLV时Cdyn降低、Pplat、Raw增加(P<0.05);与C组比较,P2组、P0组OLV时Cdyn、Pplat升高、TLV时Raw降低(P<0.05);与P2组比较,P0组OLV时Raw降低(P<0.01)。结论在开胸手术OLV期间,小Vt(Vt=6 ml/kg)结合Pinf值的PEEP的肺保护性通气方式可提高术前肺功能正常或轻度减低患者的胸肺Cdyn、降低Raw,但对术中无低氧血症的患者的氧合没有影响。更多还原

【Abstract】 Objective Lung protective ventilation strategy can reduce mortality of patients with acute respiratory distress syndrome(ARDS) and improve lung function.However,its effect on patients undergoing thoracotomy during one-lung ventilation(OLV) is still under research.The aim of this study was to investigate the effects of lung protective ventilation strategy based on the P-V curve on gas exchange function and respiratory mechanics in patients undergoing thoracotomy during OLV.Methods Thirty-eight ASA class Ⅰ or Ⅱ patients with normal or mildly decreased lung function(MVV>70% and FEV1>60%) scheduled for selective thoracotomy were randomly divided into group C(conventional ventilation,Vt=10 ml/kg,PEEP=0,n=12),group P0(Vt=6 ml/kg,PEEP=Pinf+0 cmH2O,n=12),and group P2(Vt=6 ml/kg,PEEP=Pinf+2 cmH2O,n=13).Arterial blood samples were collected for blood gas analysis before operation and 20 minutes after OLV and two-lung ventilation(TLV) in lateral decubitus after anesthesia.Airway plateau pressure(Pplat),airway resistance(Raw) and dynamic compliance(Cdyn) were recorded by side stream spirometry 5 minutes after TLV and OLV.Results Compared with pre-operation,both PaO2 and P(A-a)DO2 were increased during OLV and TLV in all the three groups,the former was higher during TLV(P<0.01),while the latter during OLV(P<0.01).There were no statistical differences in P(A-a)DO2 and PaO2 among the three groups at the same time points(P>0.05).Compared with TLV,Cdyn was decreased,while Pplat and Raw increased during OLV(P<0.05).Groups P2 and P0 showed higher Cdyn and Pplat during OLV and lower Raw during TLV than group C(P<0.05),and group P0 exhibited decreased Raw during OLV in comparison with group P2(P<0.01). Conclusion During one-lung ventilation for thoracotomy,lung protective ventilation strategy(Vt=6 ml/kg and PEEP=Pinf) can improve Cdyn,reduce Raw in patients with normal and mildly decreased lung function,but has no effect on oxygenation in patients without hypoxemia.更多还原