单肺通气时机械通气方式对每搏量变异度的影响  

Effects of different mechanical ventilation on the stroke volume variation of patients who suffered thoracotomy with one-lung ventilation

作　　者：张立贤[1] 彭亮[1] 王琳[1] 王爱群[1] 陈伟龙 曹阳[1] 

机构地区：[1]广州市红十字会医院暨南大学医学院第四附属医院麻醉科,广东广州510220

出　　处：《中日友好医院学报》2016年第3期153-156,共4页Journal of China-Japan Friendship Hospital

摘　　要：目的:探讨单肺通气时不同机械通气方式对每搏量变异度(SVV)的影响。方法:选择择期开胸手术的患者56例,分为左侧开胸组(L组)和右侧开胸组(R组)。麻醉诱导后先采用容量控制模式下的双肺通气,开胸前5min行单肺通气,将L组随机分为容量通气模式组(LV组)与压力通气模式(LP)组;R组分为容量通气模式组(RV组)与压力通气模式(RP组)。记录麻醉诱导前(T0)、诱导后双肺通气10min(T1)、侧卧位后10min(T2)、单肺通气5min(T3)、开胸后5min(T4)、开胸后30min(T5)、开胸后60min(T6)及手术结束(T7)时的SVV值。结果:4组患者在T2时,SVV值显著低于T1(P>0.05);T4时,LV组、LP组的SVV较T3时显著降低(P<0.05),RV组、RP组则无显著差异(P>0.05)。SVV组间比较:T4时,LV组、LP组显著低于RV组、RP组(P<0.05),单肺通气期间(T4、T5、T6、T7),LP组高于LV组、RP组高于RV组(P>0.05)。结论:左侧开胸时SVV的变化明显,而右侧开胸时SVV受影响较小;在同侧开胸条件下,PCV模式对患者的SVV的影响大于应用VCV模式的患者。Objective：To analyze the impact of different mechanical ventilation on the stroke volume variation（SVV）in patients who underwent thoracotomy with one-lung ventilation（OLV）.Methods：Fifty six patients undergoing thoracotomy were divided into two groups as the left thoracotomy group（L）and the right thoracotomy group（R）.After anesthesia induction,all patients were endotracheally intubated with double lumen endobronchial tubes（DLT）.Five minutes after OLV,L group were randomly divided into volume controlled ventilation（VCV）mode（LV）group and pressure controlled ventilation（PCV）mode（LP）group,R group were divided into VCV mode（RV）group and PCV mode（RP）.SVV value was recorded at the time before anesthesia induction（T0）,10 minutes after double lumen ventilation（T1）,10 minutes after lateral position（T2）,5 minutes after OLV（T3）,5 minutes after thoracotomy（T4）,30 minutes（T5）,60 minutes（T6）and the end of operation（T7）.Results：SVV value in four groups at T2 decreased compared it at T1（P〉0.05）,SVV in LV group and LP group decreased significantly at T4 compared that at T3（P〈0.05）,while there were no significant differences in SVV between the RV group and the RP group.SVV in LV group and the LP group was lower than that in group the RV and RP group at T4（P〉0.05）.During OLV（T4,T5,T6,T7）,SVV in the LP group was higher than that in the LV Group.SVV in the RP group was higher than that in the RV group（P〉0.05）.Conclusion：The SVV was affected during the left thoracotomy,while it was hardly affected during the right thoracotomy.Under the condition of the ipsilateral thoracotomy,the effect of pressure controlled ventilation on SVV was greater than the volume controlled ventilation.

关 键 词：开胸 单肺通气 机械通气模式 每搏量变异度 

分 类 号：R614[医药卫生—麻醉学]