单肺通气时对血气值及肺分流量影响的临床研究  

Influence of One-lung Ventilation on the Blood Gas and Pulmonary Shunt Fraction

作　　者：廖志品[1] 田玉科[1] 张传汉[1] 汤红[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,湖北武汉430030

出　　处：《医学临床研究》2005年第6期769-770,774,共3页Journal of Clinical Research

摘　　要：【目的】探讨肺癌行肺叶切除术单肺通气时,单肺通气(OLV)对患者动脉血气值及肺内分流的影响。【方法】择期肺癌行肺叶切除术患者40例,ASAI～Ⅱ级,静脉快速诱导后插入双腔气管导管,行双肺机械通气(TLV),30min后改健肺单肺通气。同时术侧肺通气随机分为4组,每组10例:A组,不给氧;B组,持续氧流量给氧5L/min;C组,用Bain环路行CPAP;D组,用高频喷射通气(HFJV),并在双肺通气和单肺通气各30min后取动静脉血作血气分析并计算分流率(Qs/Qt)。【结果】A、B两组OLV与TLV相比,PaO2和PVO2有极显著或显著性差异,AaDO2和(Qs/Qt)也有极显著或显著性差异,证明低氧血症与OLV时严重肺内分流有关。而C、D两组差异无显著性(P>0.05)。【结论】Bain环路和高频喷射通气用于手术侧肺,能使患肺扩张并进行气体交换,有助于提高氧合,减少肺内分流,改善低氧血症。[Objective]To explore influence of one-lung mechanical ventilation (OLV)on the blood gas and Qs/Qt ,due to pneumonoresection for lung cancer.[Methods]Forty patients with ASA Ⅰ~Ⅱ, scheduled for selective pneumonoresection for lung cancer were intubated with double-lumen tubes under intravenous anesthesia. Two-lung mechanical ventilation (TLV) for 30 min turned to health lung one-lung mechanical ventilation.Simultaneously sick lung ventilation was randomly divided into four groups with 10 patients in each group. Group A, no oxygen offer; Group B, offering oxygen in coutinuous flow in 5L/min; Group C,continuous positive airway pressure (CPAP) in Bain circuit ;Group D,high frequency jet ventilation (HFJV). Artery and vein blood gas analyses were made after TLV 30 min and OLV 30 min, and the shunt fraction Qs/Qt calculated as well.[Results]PaO2 and P V O2 in Group A、B under OLV were significantly lower than those during TLV. A-aDO2 and Qs/Qt were significantly higher, showing that hypoxemia was related with serious intrapulmonary shunt during OLV. There was no significant difference in Group C、D( P >0.05).[Conclusion]Bain circuit and HFJV can expand sick lung alveoli and gas exchange is complete in operating lung. They can improve systemic oxygenation, reduce intrapulmonary shunt and prevent hypoxemia during OLV.

关 键 词：肺通气 血气分析 

分 类 号：R332.2[医药卫生—人体生理学]