不同单肺通气策略在微创二尖瓣置换术中的应用观察  

Different single lung ventilation strategies in minimally invasive mitral valve replacement

作　　者：刘超[1] 凌中义[1] 肖琛嫦[2] 

机构地区：[1]武汉亚洲心脏病医院麻醉科,湖北省武汉市430022 [2] 武汉科技大学城市学院医学部

出　　处：《中国心血管病研究》2015年第2期170-172,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨不同单肺通气策略对微创二尖瓣置换术患者氧合功能和呼吸力学的影响.方法 选择2013年10月到2014年5月我院60例择期行微创二尖瓣置换术患者,按不同的单肺通气策略分为A、B两组,各30例.A组采用传统容量控制通气（OLV-VCV）,B组采用肺复张（LRM）＋压力控制通气（OLV-PCV）＋5 cm H2O PEEP.在麻醉诱导后双肺通气（T1）、CPB停机后OLV 15 min（T2）、CPB停机后OLV 30 min（T3）、术后双肺通气（T4）时间段,记录实测气道峰压（Ppeak）、气道阻力（Raw）、肺顺应性（Cdyn）、氧合指数（OI）,以及术后低氧血症、ICU时间、机械通气时间、肺不张和肺部感染的发生情况.结果 与A组比较,B组OI在T2[（152.2±38.6）mm Hg]、T3[（135.2±27.5）mm Hg]、T4[（342.5±31.6）mm Hg]时升高（P＜0.01）,Cdyn在T2[（35±5）ml/cm H2O]、T3[（33±5）ml/cm H2O]时增加（P＜0.05）,Ppeak在T2[（21.5±2.2）cm H2O]、T3[（21.2±4.3）cm H2O]时降低（P＜0.05）,Raw在T2[（17.2±3.9）cm H2O·L^-1·s^-1]、T3[（18.3±3.4）cm H2O·L^-1·s^-1]时降低（P＜0.05）.B组术后低氧血症（6.7％）、肺不张（6.7％）、延迟拔除气管导管（3.3％）的发生率降低（P＜0.05）.结论 LRM＋PVC＋5 cm H2O PEEP单肺通气策略,可明显提高肺顺应性,改善氧合,减少患者的并发症,改善预后.Objective To investigate the effects of different single lung ventilation strategies on oxygenation and respiratory mechanics in patients undergoing minimally invasive mitral valve replacement. Methods 60 patients underwent minimally invasive mitral valve replacement were recruited. They were divided into Group A（u= 30 ） and Group B（n=30） depended on different single lung ventilation strategies. Volume control ventilation（ OLV-VCV ） was used in Group A, while lung recruitment maneuvers（LRM ）＋pressure controlled ventilation（OLV-PCV ） ＋5 cm H20 PEEP were used in Group B. Peak airway pressure, airway resistance, lung thorax compliance, oxygenation index were recorded in four different time： Tl-two lung ventilation after induction of anesthesia, T2-single lung ventilation for 15 rain after CPB, T3-single lung ventilation for 30 min after CPB, T4-two lung ventilation after surgery. Meanwhile, postoperative hypoxemia, ICU stay, the duration of ventilation, atelectasis and pulmonary infection were recorded. Results Compared with Group A, OI increased in Group B and the difference was significant（P〈0.01 ） at T2（152.2±38.6）mm Hg and T3（135.2±27.5）mm Hg, Cdyn increased and the difference was significant（P〈0.01） at T2 （35＋5）ml/cm H20 and T3（33＋5）ml/cm H20. Ppeak reduced（P〈0.01） at T2 （21.5±2.2 ）cm H20 and T3（ 21.2±4.3 ）cm H20, Raw reduced（P〈0.01） at T2（ 17.2±3.9 ）cm H2O·L^-1·s^-1 and T3（ 18.3±3.4 ） cm H2O·L^-1·s^-1. Ol increased （P〈0.01） at T4 （342.5±31.6）mm Hg in Group B. The incidence of hypoxemia （6.7%）, atelectasis（6.7%） and delaying extubation（3.3%） reduced（P〈0.05） in Group B. Conclusion The single lung ventilation strategy of LRM＋PVC＋5 cm H20 PEEP could improve the compliance of lung and oxygenation,reduce the complications and improve the prognosis obviously.

关 键 词：单肺通气 肺复张 通气模式 

分 类 号：R614.2[医药卫生—麻醉学]