压力控制通气-容量保证单肺通气模式对老年食管癌根治术患者呼吸力学的影响  

Effect of One-lung Ventilation with Pressure Control Ventilation-volume Guarantee on Respiratory Mechanics in Elderly Patients Undergoing Radical Esophageal Cancer Surgery

作　　者：原皓[1] 邹亮[1] 孙莉[1] 

机构地区：[1]中国医学科学院肿瘤医院麻醉科,北京100021

出　　处：《医学临床研究》2014年第8期1457-1458,1461,共3页Journal of Clinical Research

摘　　要：【目的】探讨压力控制通气-容量保证（PCV-VG）单肺通气（OLV）模式对老年食管癌根治术患者呼吸力学的影响。【方法】将40例行食管癌根治术的老年患者（ASA Ⅰ～Ⅱ级）分为两组，每组20例。所有患者采取七氟烷吸入维持麻醉，插入双腔气管导管。手术进胸前先行双肺定容通气（VCV），潮气量（VT）10mL/kg，通气频率（f）12次/分钟；进胸后行OLV。A组采用VCV模式，VT为8mL/kg，f为12次/分；B组采用PCV-VG模式，压力限定设为双肺通气时的气道峰压（Ppeak），VT为8mL/kg，f为12次/分。分别于OLV前（T1）、OLV30min（T2）、OLV60min（T3）、和恢复双肺通气（TLV）30min（T4）4个时点观察患者 VT、分钟通气量（MV）、Ppeak、平均气道压（Pmean）、呼气末二氧化碳分压（PET CO2）和计算肺有效动态顺应性（Cdyn）。【结果】与A组比较，B组Ppeak、Pmean降低，VT 、MV、PET CO2无显著性差异，而Cdyn升高。【结论】老年患者食管癌根治术OLA时采用PCV-VG模式可降低Ppeak ，同时又保证了通气量，改善了Cdyn ，利于老年患者肺保护。[Objective]To explore the effect of one-lung ventilation （OLV ） with pressure control ventilationvolume guarantee（PCV-VG） on respiratory mechanics in elderly patients undergoing radical esophageal cancer surgery .[Methods] Totally 40 elderly patients（ASA Ⅰ ～ Ⅱ） undergoing radical esophageal cancer surgery were divided into two groups with 20 in each .All patients were given sevoflurane inhalation for maintenance anesthesia and intubated with double lumen endotracheal catheter .Two-lung volume controlled ventilation（VCV） with a tidal volume（VT） of 10ml/kg and frequency（f） of 12 breaths per minute were performed before chest opening .After chest was opened ,OLV was performed .Group A received VCV mode with a VT of 8ml/kg and f of 12 breaths per minute .Group B received PCV-VG mode with the same peak airway pressure （Ppeak） as that during two-lung VCV ,VT of 8ml/kg and f of 12 breaths per minute .The VT ,minute volume（MV） ,Ppeak ,mean airway pressure（Pmean） ,endtidal pressure of carbon dioxide （PET CO2 ） and dynamic lung compliance （Cdyn） before OLA （T1 ） ,30min after OLA（T2 ） ,60min after OLA（T3 ） and 30min after two-lung ventilation（TLA） were observed . Lung effective dynamic compliance（Cdyn） was calculated .[Results]Compared with group A ,Ppeak and Pmean in group B were decreased ,but there was no significant difference in VT ,MV and PET CO2 ,and Cdyn was increased .[Conclusion] PCV-VG mode in OLA for elderly patients undergoing radical esophageal cancer surgery can decrease Ppeak ,ensure ventilatory capacity and improve Cdyn ,so it is good for lung protection in elderly patients .

关 键 词：肺通气 呼吸  人工 压力 食管肿瘤/外科学 呼吸力学 老年人 

分 类 号：R735.1[医药卫生—肿瘤]