呼气末正压对单肺通气患者围手术期肺功能的影响  

Effect of positive end expiratory pressure on pulmonary function of one-lung ventilation patient during perioperation

作　　者：丁培炎[1] 阎文军[1] 赫曼[1] 刘若彬[1] 马亚兵[1] 

机构地区：[1]甘肃省人民医院麻醉科,兰州730000

出　　处：《中国医师进修杂志》2011年第18期1-3,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨呼气末正压（PEEP）对单肺通气患者术中动脉氧合和肺内分流及术后肺功能的影响。方法40例肺功能正常、ASA分级Ⅰ～Ⅱ级、择期行肺叶切除术患者按随机数字表法分为对照组和PEEP组，每组20例。所有患者经静脉麻醉快速诱导后行双腔气管导管插管并双肺通气，潮气量10ml／kg，呼吸频率12次／min。开胸后改为健侧肺单肺通气，潮气量6ml／kg，呼吸频率16～18次／min。对照组无PEEP，PEEP组加用5cmH：O（1cmH20=0．098kPa）PEEP。连续监测血流动力学和呼吸力学参数，并测定术前和术后72h肺功能。结果与单肺通气前比较，两组单肺通气30min动脉血氧分压、脉搏血氧饱和度、氧合指数均显著下降，肺内分流率（Qs／Qt）显著增加（P〈0．01或〈0．05），且对照组变化更显著（P〈0．05）。两组术后72h第1秒用力呼气容积（FEV，）占预计值百分比（FEVl％）、用力肺活量（FVC）占预计值百分比（FVC％）、FEV。／FVC均较术前显著降低[对照组术前：（121．8±25．1）％、（117．2±24.3）％、（87．6±15．7）％，术后72h：（84．9±21．6）％、（77．2±18．3）％、（70．5±12．5）％；PEEP组术前：（116．9±24．5）％、（112．1±23．6）％、（85．3±13．8）％，术后72h：（96．3±20．4）％、（88．1±19．8）％、（78．4±10．2）％]（P〈0．01或〈0．05），且对照组变化更显著（P〈0．05）。结论单肺通气期间加用适当的PEEP可增加动脉氧合、降低肺内分流、改善肺功能，从而降低围手术期患者低氧血症的发生和减轻单肺通气所致的肺损伤。Objective To explore the effect of positive end expiratory pressure （PEEP） on arterial oxygenation and intrapulmonary shunt during one-lung ventilation （OLV） and pulmonary function during perioperation. Methods Forty patients with normal pulmonary function,ASA Ⅰ-Ⅱ,scheduled for pulmonary lobectomy, were divided into control group and PEEP group by random digits table with 20 cases each. Patients were induced by double-lumen tube,,; under intravenous anesthesia and were received 10 ml/kg tidal volume, 12 frequents/min breathing rate during the two-lung ventilation （TLV）, secondary reduced to 6 ml/kg tidal volume, 16-18 frequents/min breathing rate without PEEP （control group） or with 5 em H2O（ 1 cm H20 = 0.098 kPa） PEEP （PEEP group） during OLV. Hemodynamics and respiratory mechanical parameters were continuously monitored, lung function before operation and at 72 h after operation was detected. Results Compared to before OLV ,arterial oxygen tension （PaO2） ,arterial oxygen saturation （SpO2）, oxygenation index （OI） were decreased and intrapulmonary shunt ratio （Qs/Qt） was increased in control group and PEEP group at 30 min after OLV （P 〈 0.01 or 〈 0.05）. However,PaO2 and SpO2 and OI were higher and Qs/Qt was lower in PEEP group than that in control group at the same time point （P〈 0.05 ）. In addition, FEV1%, FVC% and FEV1/FVC were （121.8± 25.1 ）%, （117.2 ±24.3）%, （87.6 ±15.7）% before operation and （84.9 ±21.6 ）%, （77.2 ± 18.3 ）%, （70.5 ±12.5 ）% at 72 h after operation respectively in control group, （116.9 ±24.5）%, （112.1 ±23.6）% , （85.3±13.8）% before operation and （96.3±20.4）%, （88.1 ±19.8）%, （78.4 ± 10.2）% at 72 h after operation respectively in PEEP group. Although decreased in control group and PEEP group at 72 h after operation comparing with preoperation （P 〈 0.01 or 〈 0.05 ）, FEV1%, FVC% and FEV1/FVC were higher in PEEP group than those in control group at 72 h after operation （P 〈

关 键 词：正压呼吸 肺通气 手术期间 

分 类 号：R614[医药卫生—麻醉学]