呼气末正压对单肺通气中氧合及分流的影响  

Effects of positive end-expiratory pressure on the oxygenation and shunt fraction during ventilation with solitary lung

作　　者：张银星 潘晓霞 赵京禹[2] 

机构地区：[1]泽州县人民医院麻醉科,山西泽州048000 [2]解放军总医院第一附属医院麻醉科,北京100037

出　　处：《解放军医学杂志》2013年第12期989-991,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨在开胸手术单肺通气中应用呼气末正压（VEEP）对患者氧合及分流的影响。方法选择2010年6—8月行肺叶切除术的患者60例，男42例，女18例，年龄38—72岁，ASA1～2级，随机均分为2组（n=30），A组采用单肺间歇正压通气（IPPV），B组采用单肺IPPV加PEEP（5cmH2O）通气。分别于平卧位双肺通气（T1）、侧卧位双肺通气10min（T2）、单肺通气10min（T3）和30min（T4）4个时间点取血行动脉血气分析，并监测平均肺动脉压（PAP）、平均动脉压（MAP）、心率（HR）、动脉血氧分压（PaO2）、混合静脉血氧饱和度（SvO2），计算分流（Qs／Qt）值。结果A组T3、T4时间点Pao2与T1比较明显下降（P〈0．05，P〈0．01），pH、PaCO2、HCO^-3、BE各时间点比较差异无统计学意义，B组各时间点动脉血气指标比较差异均无统计学意义。A组T3、T4时间点Qs／Qt值与T1比较明显下降（P〈0．01），PAP、MAP、HR、SvO2各时间点比较差异无统计学意义，B组各时间点上述指标比较差异均无统计学意义。结论在开胸手术单肺通气中应用PEEP可明显提高动脉血氧分压，减少肺内分流。Objective To explore the effects of positive end-expiratory pressure （PEEP） on the oxygenation and shunt fraction during ventilation with solitary lung in open thoracic surgery. Methods Sixty patients （42 males and 18 females, aged 38-72 years, American Society of Anesthesiologist classification Ⅰ - Ⅱ ） received lung lobectomy from Jun. to Aug. 2010 were randomly divided into 2 groups （n=30）. The patients in group A received solitary lung intermittent positive pressure ventilation （IPPV）, and those in group B received solitary lung IPPV combined with PEEP （ScmH20）. The arterial blood gas analysis, pulmonary artery pressure （PAP）, mean arterial pressure （MAP）, heart rate （HR）, arterial partial pressure of oxygen （PaO2） and mixed venous oxygen saturation （SvO2） were monitored and recorded in both groups at the following time points： horizontal position two-lung ventilation （T1）, lateral position two-lung ventilation 10 minutes （T2）, solitary lung ventilation 10 minutes （T3） and solitary lung ventilation 30 minutes （T4）, and the pulmonary shunt fraction （Q~/Qt） was calculated. Results In group A, the PaO2 was obviously lower at T3 and T, than at T1 （P〈0.05, P〈0.01）, and there was no significant difference in pH, PaCO2, HCO3 and BE between the 4 time points. In group B, there was no significant difference of arterial blood gas values in 4 time points. The Qs/Qt value was obviously lower at T3 and T4 compared with that at T1 （P〈0.01 ）, and no significant difference in PAP, MAP, HR and SvO2 was found between the 4 time points in group A, while there was no significant difference in above indexes in 4 time points in group B. Conclusion The application of PEEP during solitary lung ventilation in open thoracic surgery may improve PaO2 and decrease pulmonary shunt fraction.

关 键 词：呼气末正压 单肺通气 血气分析 

分 类 号：R614.21[医药卫生—麻醉学]