单肺通气期间体位对血液氧合的影响  

The effects of position on oxygenation and pulmonary shunt fraction during one lung ventilation

作　　者：陈士寿[1] 陈燃[1] 曾一平[1] 李磊[1] 顾尔伟[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥市230022

出　　处：《临床麻醉学杂志》2006年第3期193-195,共3页Journal of Clinical Anesthesiology

摘　　要：目的 比较单肺通气（OLV）期间不同体位对血液氧合及肺内分流的影响。方法 15例择期开胸食管癌根治术病人，ASA Ⅰ～Ⅱ级，于仰卧位双肺通气（TLV）（T1）、仰卧位OLV 30min（T2），侧卧位开胸前OLV 30min（T3）分别进行动静脉血气分析，并计算肺内分流率（Qs／Qt）。结果 T2与T1比较，动脉血氧分压（PaO2）、混合静脉血氧分压（PvO2）、动脉血氧饱和度（SaO2）、混合静脉血氧饱和度（SvO2）和静脉血氧饱和度（CvO2）明显下降，Qs／Qt明显升高（P＜0．01），动脉血氧含量（CaO2）明显下降（P〈0．05）。T2与T1相比，PaO2明显下降，Qs／Qt明显升高（P〈0．01），SaO2明显下降（P〈0．05），PvO2、SvO2、CaO2和CvO2无明显变化。T2与T3比较，PaO2和SVO2明显下降，Qs／Qt明显升高（P〈0．01）。PvO2、SaO2和CvO2明显降低（P〈0．05）。结论 T3较T2能明显改善血液氧合，减少肺内分流。Objective To compare the effects of different positions on oxygenation and pulmonary shunt fraction during one lung ventilation. Methods Fifteen patients underwent thoracic surgery for esophagectomy,ASA Ⅰ -Ⅱ, during the period of two lung （TLV） and one lung ventilation（OLV） 30 min in the supine position OLV 30 Min before open chest in the lateral position. Arterial and venous blood gas samples were drawn for gas analysis and calculate pulmonary shunt fraction （Qs/Rt）. Results PaO2 ,SaO2 ,SvO2 and CvO2 were significantly decreased,Qs/Qt higher （P〈0.01） CaO2 higher （P〈0.05） during OLV in the supine position compared with those during TLV. PaO2 was significantly decreased （P〈0.05） during OLV in the lateral position compared with that during TLV in the supine position. PrO2 ,SvO2,CAO2 and CvO2 had no significant difference between OLV in the lateral position and TLV in the supine position. PaO2 and SvO2 were significantly decreased, Qs/Qt was significantly higher （P〈0.01）,PvO2, SaO2, and CvO2 were significantly decreased （P〈 0. 05） during OLV in the supine position compared with those during OLV in the lateral position. Conclusion Blood oxygenation was significantly better and pulmonary shunt fraction significantly decreased during OLV in the lateral position compared with those in supine position.

关 键 词：单肺通气 仰卧位 氧合 肺内分流 

分 类 号：R614[医药卫生—麻醉学] R612[医药卫生—外科学]