剖胸手术患者单肺通气时降低吸入氧浓度的可行性  

Feasibility of one lung ventilation with decreased inspiratory oxygen concentration during thoracic surgery

作　　者：许仄平[1] 顾连兵[1] 王丽君[1] 蒋大明[1] 髙蓉 冯冬杰[1] 

机构地区：[1]南京医科大学附属肿瘤医院麻醉科,江苏省210009

出　　处：《江苏医药》2013年第15期1765-1767,共3页Jiangsu Medical Journal

基　　金：江苏省自然科学基金资助项目(BK2010588);江苏省肿瘤医院青年基金(ZQ201112)

摘　　要：目的探讨剖胸手术患者单肺通气(OLV)时降低吸入氧浓度(FiO2)的安全性。方法食管癌根治术患者40例,随机均分为两组:L组OLV时FiO2=60%;C组OLV时FiO2=90%。于OLV前(T1)、OLV 30min(T2)、60min(T3)、120min(T4)和恢复双肺通气(TLV)后30min(T5)行血气分析,监测并记录相关的通气和循环指标。结果 T2、T3、T4时,L组动脉血氧饱和度(SaO2)、PaO2明显低于C组(P<0.05)。OLV期,L组5例(25%)患者SpO2降到95%以下,通过提升20%的FiO2处理后,SpO2均上升到95%以上,C组SpO2均>95%。OLV期两组其他呼吸、循环指标无统计学差异(P>0.05)。结论 OLV期,FiO2为60%时患者循环稳定,但对部分左剖胸食管癌患者可能有低氧血症的潜在风险,应加强SpO2的监测。Objective To investigate the feasibility of one lung ventilation（OLV）with decreased inspiratory oxygen concentration（FiO2）during thoracic surgery.Methods Fourty patients undergoing radical surgery for esophageal cancer were equally randomized into two groups of L（OLV with FiO260%）and C（OLV with FiO290%）.Arterial gas analysis was performed before OLV（T1）,at 30（T2）,60（T3）and 120minutes（T4）during OLV and 30minutes after turning back to two lung ventilation（T5）.The ventilation and circulation-related criteria were monitored as well.Results Arterial oxygen saturation（SaO2）and arterial partial pressure of oxygen（PaO2）at T2-T4 were significantly lower in group L than those in group C（P〈0.05）.During OLV,pulse oxygen saturation（SpO2）dropped below 95%in 5cases of group L,which was returned to more than 95% after 20% increase of FiO2.The SpO2 was kept more than 95%all the time during OLV in group C.There were no significant differences in the rest criteria related to ventilation and circulation between two groups.Conclusion The circulation could be maintained stable during OLV when FiO2is reduced to 60%,but some of the patients run a potential risk for hypoxemia and monitoring of SpO2 should be strengthened.

关 键 词：单肺通气 血氧饱和度 食管癌 

分 类 号：R614[医药卫生—麻醉学]