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

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

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

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

出　　处：《临床麻醉学杂志》2005年第1期26-28,共3页Journal of Clinical Anesthesiology

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)、 患侧肺0cmH2OPEEP健侧肺5cmH2OPEEP后15min(A3)、患侧肺5cmH2OCPAP健侧肺0 cmH2OPEEP后15min(A4)、患侧肺5cmH2OCPAP健侧肺5cmH2OPEEP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)、混合静脉血氧分压 (P VO2)、动脉血氧饱和度(SaO2)、混和静脉血氧饱和度(S VO2)并计算分流( Qs/ Qt)值。B组用10 cmH2OPEEP和10cmH2OCPAP重复上述过程。结果　与A2相比,A3、A4和A5PaO2显著增加, Qs/ Qt值显著降低(P<0.05),但A3、A4、A5间相比较则无显著性差异(P>0.05)。B组各时点的 各项指标变化与A组类同。结论　在VATS行单肺通气麻醉时,健肺使用PEEP、患肺使用CPAP 或联合使用PEEP和CPAP能提高患者手术中的氧合作用,降低 Qs/ Qt值;与5cmH2OPEEP和 CPAP比较,10cmH2OPEEP和CPAP不能进一步改善PaO2和 Qs/ Qt。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 groups A and B. In group A,arterial oxygenation, shunt fraction and hemodynamics were monitored at 15min after the start of operation(A 1), 15min after one-lung ventilation(A 2), 15min after 0 cmH 2O CPAP to the nondependent lung and 5 cmH 2O PEEP to the dependent lung (A 3), 15min after 5 cmH 2O CPAP to the nondependent lung and 0 cmH 2O PEEP to the dependent lung (A 4), 15 min after 5 cmH 2O CPAP to the nondependent lung and the 5 cmH 2O PEEP to the dependent lung (A 5). In group B,with application of 10 cmH 2O CPAP and 10 cmH 2O PEEP instead of 5cmH 2O as in group A. Results Arterial partial pressure of oxygen(PaO 2) increased and shunt fraction(s/t) values decreased significantly after application of PEEP, CPAP, and combination of PEEP and CPAP in both group A and B(P<0.05). There were no significant difference in PaO 2 and s/t between group A and B.Conclusion The application of PEEP to the dependent lung, CPAP to the nondependent lung, and the combination of PEEP and CPAP, are useful for improving oxygenation and decreasing shunt fraction, the application of 10cmH 2O PEEP and CPAP cannot improve oxygenation and shunt fraction further compared with 5cmH 2O PEEP and CPAP.

关 键 词：PEEP CPAP 电视辅助胸腔镜手术 单肺通气 氧合作用 分流的影响 麻醉 

分 类 号：R614[医药卫生—麻醉学]