单肺通气下肺癌根治术患者血流动力学和血管外肺水的变化  

Hemodynamics and extravascular lung water during one-lung ventilation in lung cancer surgeries

作　　者：张文婷[1] 黄冰[1] 黎阳[1] 杜学柯[1] 

机构地区：[1]广西医科大学肿瘤医院麻醉科,南宁530021

出　　处：《临床麻醉学杂志》2011年第6期532-534,共3页Journal of Clinical Anesthesiology

基　　金：广西自然科学基金项目(项目编号:桂科自0832232)

摘　　要：目的探讨单肺通气(OLV)是否为影响OLV下肺癌根治术患者术中、术后血管外肺水(EVLW)的独立因素。方法 20例因肺癌行肺叶切除术患者,术式相同,随机分为OLV组和双肺通气(TLV)组。所有患者均行股动脉穿刺并置入热敏导管,连接到脉搏指示剂连续心排出量(PiCCO)监护仪,记录手术开始前、通气30、60、120、150 min,术后1、3、5、20 h的中心静脉压(CVP)、心排出量(CO)、平均动脉压(MAP)、全身血管阻力指数(SVRI)、血管外肺水指数(EVLWI)等血流动力学指标。结果两组间各血流动力学指标比较差异均无统计学意义。两组CO术中基本保持平稳,拔管前增加,拔管后稳定在较高水平(P<0.05或P<0.01);CVP术后1、3 h升高(P<0.01);MAP术中升高,术后下降,但维持在高于术前的水平;SVRI在术前减低,术中升高,术后迅速回落至术前水平。EVLWI随时间延长呈逐渐降低趋势。结论 OLV对肺癌根治术患者EVLW影响轻微,是一项安全的麻醉操作。Objective To investigate whether OLV is an independent factor of EVLW in lung cancer surgery. Methods Twenty patients undergoing the same lung cancer surgery were rando rely divided into OLV group and TLV group with 10 cases each. Hemodynamics （including CVP, CO, MAP,SVRI,EVLWI） were monitored and recorded by the PiCCO monitor before surgery, 30, 60, 120, 150 min after ventilation and 1, 3, 5, and 20 h after surgery. Result8 There was no significant difference in hemodynamies between the two groups. CO increased before tracheal extubation, and stabilized at a higher level. CVP increased at 1,3 h after the operation. MAP increased during surgery and decreased after surgery, but remained higher than baseline. SVRI decreased before surgery, increased during surgery, and declined rapidly to baseline. EVLWI showed a decreasing trend with time. Conclusion OLV is a safe anesthesia technique with mild effect on EVLW in lung cancer surgery patients.

关 键 词：脉搏指示剂连续心排出量 单肺通气 肺癌 血流动力学 血管外肺水 

分 类 号：R614[医药卫生—麻醉学]