术侧肺间断机械通气对肺切除术后病人复张性肺水肿的预防效果  

Efficacy of intermittent ventilation performed in lungs on operated side for prevention of reexpansion pulmonary edema after pulmonary resection

作　　者：张伟[1] 张加强[1] 孟凡民[1] 

机构地区：[1]河南省人民医院麻醉科,郑州市450003

出　　处：《中华麻醉学杂志》2015年第4期409-411,共3页Chinese Journal of Anesthesiology

基　　金：河南省科技厅项目（122300410068）

摘　　要：目的 评价术侧肺间断机械通气对肺切除术后病人复张性肺水肿的预防效果.方法 择期胸腔镜辅助下行肺切除术病人40例,性别不限,年龄16～32岁,体重指数18～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组（n=20）：对照组（C组）和术侧肺间断机械通气组（Ⅴ组）.麻醉诱导后行气管插管,机械通气,采用纤维支气管镜定位准确后即改为单肺通气.C组术中常规单肺通气;Ⅴ组单肺通气期间对术侧肺行间断机械通气,潮气量2 ml/kg,通气频率20次/min,通气30 s后停止,支气管导管开口于大气中,10 min后重复上述操作,直至病变组织切除完毕.于病变组织取出后取其周边正常肺组织,检测肺组织水通道蛋白1（AQP-1）和AQP-5的表达水平;记录术后24 h内肺不张、低氧血症和复张性肺水肿的发生情况.结果 与C组比较,Ⅴ组肺组织AQP-1和AQP-5表达上调,术后24 h内肺不张和复张性肺水肿的发生率降低（P＜0.05）,低氧血症发生率差异无统计学意义（P＞0.05）.结论 肺切除术病人单肺通气期间,术侧肺行间断机械通气可有效地预防术后复张性肺水肿的发生.Objective To evaluate the efficacy of intermittent ventilation performed in lungs on the operated side for prevention of reexpansion pulmonary edema after pulmonary resection.Methods Forty patients of both sexes,aged 16-32 yr,with body mass index of 18-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective thoracoscope-assisted pulmonary resection,were randomly divided into 2 groups （n =20 each） using a random number table：control group （group C） and intermittent ventilation performed in lungs on the operated side group （group Ⅴ）.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.After correct positioning was confirmed by fiberoptic bronchoscopy,one-lung ventilation was performed instead.One-lung ventilation was performed routinely in group C.In group Ⅴ,the lung on the operated side was ventilated intermittently for 30 s with the tidal volume set at 2 ml/kg and respiration rate at 20 bpm,the bronchial tube was then opened,and the process was repeated at 10 min intervals until the diseased tissues were removed.After resection of diseased tissues,the specimens of normal tissues around the area were obtained for determination of the expression of aquaporin 1 （AQP-1） and AQP-5 in lung tissues.The development of pulmonary atelectasis,hyoxemia and reexpansion pulmonary edema was recorded within 24 h after surgery.Results Compared with group C,AQP-1 and AQP-5 expression was significantly up-regulated,the incidence of atelectasis and reexpansion pulmonary edema was decreased within 24 h after surgery,while no significant change was found in the incidence of hyoxemia in group Ⅴ.Conclusion Intermittent ventilation performed in lungs on the operated side can effectively prevent the development of reexpansion pulmonary edema during one-lung ventilation in the patients undergoing pulmonary resection.

关 键 词：呼吸 人工 肺水肿 手术后并发症 

分 类 号：R614[医药卫生—麻醉学]