大容量全肺灌洗对肺内分流和血气的影响  

Impact of Massive Whole-lung Lavage on Intrapulmonary Shunt and Blood Gas during One-lung Ventilation

作　　者：刘先军[1] 彭吉霞[2] 向勇[3] 杜春玲[1] 刘玉全[1] 涂明利[1] 

机构地区：[1]湖北医药学院附属太和医院呼吸内科,湖北十堰442000 [2]湖北医药学院机能实验室 [3]湖北医药学院附属太和医院麻醉科,湖北十堰442000

出　　处：《华南国防医学杂志》2011年第1期22-24,共3页Military Medical Journal of South China

摘　　要：目的观察大容量全肺灌洗术(whole-lung lavage,WLL)中患者单肺通气期间肺灌洗对肺内分流和血气的影响。方法对40例符合条件的尘肺和肺泡蛋白沉积症患者进行80例次大容量全肺灌洗术,在患者双肺通气时(T0)、单肺通气时(T1)、液体完全灌入后(T2)和液体引流完全后(T3)各时间点抽取动脉血和混合静脉血行血气分析,并根据血气分析结果计算肺内分流率(Qs/Qt)。结果肺内分流率:T1、T3均较T0时刻增加,T2较T1时刻减少,T3较T1、T2时刻增加,T2较T0时刻差异无统计学意义。PaO2:T1时刻较T0时刻降低,T2时刻较T1时刻升高,T3时刻较T0、T1、T2时刻均显著降低。pH、二氧化碳分压、动脉血氧饱和度、静脉血氧饱和度、静脉氧分压在各时刻比较变化差异均无统计学意义。结论大容量全肺灌洗术中液体的灌入可减少肺内分流,导致血氧分压回升,液体的引流有相反的作用,血氧饱合度(blood oxygen saturation,SaO2)在正常范围。掌握好适应症,WLL是安全的。Objective To observe the impact of lung lavage on intrapulmonary shunt and blood gas during one-lung ventilation （OLV） in massive whole-lung lavage （WLL）. Methods Eighty WLL operations on 40 patients with pneumoconiosis or pulmonary alveolar proteinosis were performed. The arterial blood and mixed venous blood were extracted for blood gas analysis 15 minutes after double-lung ventilation （T0）, 15 minutes after OLV （T1）, 1 minute after lung lavage （T2） and 1 minute after draining up （T3）. Intrapulmonary shunt （Qs/Qt） was calculated. Results Qs/Qt increased at T1 and T3 compared with those at T0, decreased at T2 than T1, increase at T3 than T1 and T2 （P0.05）. No significant difference was observed at T2 and T0. PaO2 decreased at T1 than T0, increased at T2 than T1, and decreased at T3 than T0, T1 and T2 （P0.05）. There were no significant changes in pH, PaCO2 and PvCO2 at different timepoints. Conclusion During WLL fluid injection can reduce the intrapulmonary shunt and increase PaO2,fluid drainage has inverse impact, but blood oxygen saturation （SaO2） can be kept in normal range. WLL is safe for proper indications.

关 键 词：大容量全肺灌洗 单肺通气 肺内分流率 血气 

分 类 号：R563[医药卫生—呼吸系统]