不同压力的PEEP和CPAP在电视辅助胸腔镜手术下行单肺通气时对氧合作用及分流的影响  

The effect of different PEEP and CPAP on the oxygenation and shunt fraction during one-lung ventilation in VATS

作　　者：杨晓明[1] 刘珺[2] 江辉[3] 任俊清[1] 孙晓东[1] 伍青[4] 

机构地区：[1]空军总医院麻醉科,北京100036 [2]空军总医院信息科 [3]华中科技大学同济医学院附属同济医院麻醉科,武汉430030 [4]空军总医院胸外科

出　　处：《空军总医院学报》2004年第3期155-158,共4页Journal of General Hospital of Air Force,PLA

摘　　要：目的　评价呼气末正压通气 (PEEP)和连续气道正压通气 (CPAP)在电视辅助胸腔镜手术 (VATS)行单肺通气麻醉时对患者血氧合作用的影响。　方法　选择 30例在VATS下行肺叶切除的单纯肺癌患者 ,随机分为A、B两组。A组于手术开始后 15min(A1)、单肺通气后 15min(A2 )、术肺 0CPAP健肺 5cmH2 OPEEP后 15min(A3 )、术肺 5cmH2 OCPAP健肺 0PEEP后 15min(A4)、术肺 5cmH2 OCPAP健肺 5cmH2 OPEEP后 15min(A5)分别监测平均肺动脉压 (PAP)、平均动脉压(MAP)、心率 (HR)、动脉血氧分压 (PaO2 )、动脉血氧饱和度 (SaO2 )、混和静脉血氧饱和度 (SvO2 )并计算分流 (Qs/Qt)值。B组用 10cmH2 OPEEP和 10cmH2 OCPAP重复上述过程。　结果　A组间PAP、MAP、HR、PvO2 、SaO2 以及SvO2 无显著性差异 (P >0 0 5 ) ;与A2 (PaO2 :119 5± 2 8 7,Qs/Qt :35 7± 6 3)时相比 ,A3 时的PaO2 ( 2 0 0 8± 30 6 )显著增加 ,Qs/Qt值 ( 2 3 8±6 5 )显著降低 ;A4时的PaO2 ( 2 2 1 4± 16 6 )显著增加 ,Qs/Qt值 ( 2 4 8± 5 9)显著降低 ;A5时的PaO2 ( 2 4 0 2± 4 6 3)显著增加 ,Qs/Qt值 ( 2 3 5± 6 4 )显著降低 (P <0 0 5 ) ,A3 ,A4,A5间相比较无显著差异 (P >0 0 5 )。B组间PAP、MAP、HR、PvO2 、SaO2 以及SvO2 无显著性差?Objective To evaluate the effect of PEEP and CPAP on the oxygenation and shunt fraction during one lung ventilation in Video associate thorax cope surgery(VATS) Methods Thirty patients with lung cancer were randomly divided into A and B groups A group: Arterial oxygenation, shunt fraction and hemodynamics were monitored at 15 min after the start of operation (A 1), at 15 min after one lung ventilation (A 2), at 15 min after the application of 0 cm H 2O CPAP to the nondependent lungs and the application of 5 cm H 2O PEEP to the dependent lungs (A 3), at 15 min after the application of 5 cm H 2O CPAP to the nondependent lungs and the application of 0 cm H 2O PEEP to the dependent lungs (A 4), at 15 min after the application of 5 cm H 2O CPAP to the nondependent lungs and the application of 5 cm H 2O PEEP to the dependent lungs(A 5) B Group with the application of 10 cm H 2O CPAP and 10 cm H 2O PEEP also Results There were no significant changes in mean pulmonary artery pressure (PAP),mean arterial blood pressure (MAP), heart rate(HR), mixed venous partial pressure of oxygen(PVO 2), arterial and mixed venous saturation of oxygen(SaO 2, SvO 2)during this study ( P >0 05) Arterial partial pressure of oxygen(PaO 2) increased and shunt fraction values decreased significantly after the application of PEEP(PaO 2: 200 8±30 6 Qs/Qt: 23 8±6 5), CPAP(PaO 2: 221 4±16 6,Qs/Qt: 24 8±5 9), and combination of PEEP and CPAP(PaO 2: 240 2±46 3,Qs/Qt: 23 5±6 4)( P <0 05) But there were no significant differences in oxygenation and shunt fraction during PEEP, CPAP or combination of PEEP and CPAP There were no significant changes in PAP, MAP, HR, PVO 2, SaO 2, SvO 2 after the application of 10 cm H 2O PEEP and CPAP ( P >0 05) PaO 2 increased and Qs/Qt decreased significantly after the application of 10 cm H 2O PEEP and CPAP ( P <0 05) There were no significant changes in PaO 2 and Qs/Qt between A group and B group Conclusion The application of PEEP

关 键 词：正压呼吸 胸外手术 电视辅助 连续气道正压通气 血气分析 

分 类 号：R332.3[医药卫生—人体生理学] R614[医药卫生—基础医学]