双肺通气时混合吸入空气可延迟单肺通气时的肺萎陷  

作　　者：Raynauld Ko, MD Karen McRae, MDCM Gail Darling, MD Thomas K. Waddell MD, PhD Desmond McGlade, MBBS, FANZCA Ken Cheung, MD Joel Katz, PhD Peter Slinger, MD 刘晓(译) 

机构地区：[1]Departments of Anesthesia and Pain Management, University Health Network, University of Toronto, Ontario, Canada [2]Surgery, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada [3]不详

出　　处：《麻醉与镇痛》2011年第3期61-65,共5页Anesthesia & Analgesia

摘　　要：背景一侧肺萎陷有助于显露胸外科手术的手术野。双肺通气时吸入不同的混合气体可通过加速或延迟肺萎陷过程，从而改善或影响单肺通气时的手术条件。我们观察了双肺通气时吸入3种不同的混合气体对单肺通气时肺萎陷和氧合的影响：空气／氧气（FiO2=0．4）、氧化亚氮（N2O）／氧气（FiO2=0．4）、氧气（FiO2=1．0）。方法将受试者随机分为3组：空气／氧气组（n=33）、N2O组（n=34）和O2组（n=33），麻醉诱导时吸入不同的混合气体直至开始单肺通气。在单肺通气过程中所有受试者的FiO2均为1．0。手术者不参与分组，并在单肺通气开始后10和20分钟的时间点用口头量表评价肺萎陷的程度。在麻醉诱导前、双肺通气时以及单肺通气后的30分钟内每5分钟查一次动脉血气。结果双肺通气时混合吸入空气可延迟单肺通气时的肺萎陷，而混合吸入氧化亚氮则可加速肺萎陷。O2组的动脉氧合仅在单肺通气开始10分钟内显著改善，之后各组间的平均PaO2差异无显著性。结论双肺通气时去除肺内的氮气是改善单肺通气时手术条件的一项重要策略。双肺通气时使用FiO2=1．0或N2O／O2（FiO2=0．4）时，对单肺通气的氧合并没有明显的不利影响。BACKGROUND： Collapse of the ipsilateral lung facilitates surgical exposure during thoracic procedures. The use of different gas mixtures during two-lung ventilation （2LV） may improve or impede surgical conditions during subsequent one-lung ventilation （OLV） by increasing or delaying lung collapse. We investigated the effects of three different gas mixtures during 2LV on lung collapse and oxygenation during subsequent OLV： Air/Oxygen （ fraction of inspired oxygen [ FiO2 ] = 0. 4）, Nitrous Oxide/Oxygen （ ＂N2 O,＂ Fit2 = 0.4） and Oxygen （ ＂O2,＂ FiO2 = 1.0）. METHODS： Sub- jects were randomized into three groups： Air/Oxygen （n=33） , N2O （n=34） or O2 （n=33） and received the designated gas mixture during induction and until the start of OLV. Subjects＇ lungs in all groups were then ventilated with FiO2 = 1.0 during OLV. The surgeons, who were blinded to the randomization, evaluated the lung deflation using a verbal rating scale at 10 and 20 rain after the start of OLV. Serial arterial blood gases were performed before anesthesia induction, during 2LV, and every 5 min, for 30 rain, after initiation of OLV. RESULTS： The use of air in the inspired gas mixture during 2LV led to delayed lung deflation during OLV, whereas N2O improved lung collapse. Arterial oxygenation was significantly improved in the O2 group only for the first 10 min of OLV, after which there were no differences in mean PaO2 values among groups. CONCLUSIONS： De-nitrogenation of the lung during 2LV is a useful strategy to improve surgical conditions during OLV. The use of FiO2 1. 0 or N2 O/O2 （FiO2 0. 4） during 2LV did not have an adverse effect on subsequent oxygenation during OLV.

关 键 词：单肺通气 双肺通气 肺萎陷 空气 吸入氧化亚氮 混合气体 FIO2 动脉氧合 

分 类 号：R655[医药卫生—外科学]