. 单肺通气患者术中肺复张术的适宜频率  

Optimum frequency for lung recruitment during surgery in patients undergoing one-lung ventilation

作　　者：赵艾华[1] 宋子贤[1] 王合梅[1] 李义[1] 贾慧群[1] 李超[1] 雍芳芳[1] 杜伟[1] 

机构地区：[1]河北医科大学第四医院麻醉科,石家庄市050011

出　　处：《中华麻醉学杂志》2016年第8期998-1001,共4页Chinese Journal of Anesthesiology

摘　　要：目的 探讨单肺通气患者术中肺复张术的适宜频率.方法 择期开胸手术患者80例,性别不限,年龄48～ 64岁,体重55 ～ 80 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为不同频率肺复张术组（LR1-4组,n=20）.单肺通气时VT6 ml/kg,RR 12～16次/min,PEEP 5 cmH2O,气道峰压＜35 cmH2O,维持PETCO2 35～45 mmHg.LR1-3组分别每30、60和120 min行1次肺复张术,LR4组仅在关胸前行1次肺复张术.肺复张术方案：恢复双肺通气5 min后保持气道压达40 cmH2O并持续15 s.于入室（T0）、单肺通气即刻（T1）、单肺通气30 min（T2）、1 h（T3）、2h（T4）、3 h（T5）、结束时（T6）、恢复双肺通气30 min（T7）、气管拔管后30 min（T8）时,抽取桡动脉血样,行血气分析,计算氧合指数（OI）及肺内分流量（Qs/Qt）.分别于T0、T4、T7及术后2 h（T9）、24 h（T10）时抽取颈内静脉血样,采用酶联免疫分析法检测血清IL-6、TNF-α及IL-10浓度.结果 与LR1组比较,LR2组和LR4组T6时OI升高,Qs/Qt降低（P＜0.05）,LR3组上述指标差异无统计学意义（P＞0.05）;LR2组和LR4组各时点OI和Qs/Qt比较差异无统计学意义（P＞0.05）.与LR1组比较,LR2组和LR3组T4～T10时、LR4组T4时血清IL-6、TNF-α和IL-10浓度降低（P＜0.05）;与LR2组和LR3组比较,LR4组T7～T10时血清IL-6、TNF-0和IL-10浓度升高（P＜0.05）;LR2组和LR3组各时点血清IL-6、TNF-α和IL-10浓度比较差异无统计学意义（P＞0.05）.结论 开胸手术患者单肺通气期间肺复张的适宜频率为每60 min 1次.Objective To investigate the optimum frequency for lung recruitment during surgery in the patients undergoing one-lung ventilation （OLV）.Methods Eighty patients of both sexes,aged 48-64 yr,weighing 55-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were randomly divided into lung recruitment with different frequency groups （LR1-4 groups,n =20 each） using a random number table.The patients were mechanically ventilated （tidal volume 6 ml/kg,respiratory rate 12-16 breaths/min,positive end-expiratory pressure 5 cmH2O,and peak airway pressure〈35 crnH2O during OLV） and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.Lung recruitment was performed once every 30,60 and 120 min in LR1-3 groups,respectively,and lung recruitment was performed only once before the chest was closed in group LR4.At 5 min after restoration of two-lung ventilation,the airway pressure was maintained at 40 cmH2O for 15 s.After admission to the operating room （T0）,immediately after onset ofOLV （T1）,at 30min,1 h,2hand3 hofOLV （T2-5）,at the end of OLV （T6）,at 30 min after restoration of two-lung ventilation （T7）,and at 30 min after tracheal intubation （T8）,blood samples were collected from the radial artery for blood gas analysis,and oxygenation index （OI） and intrapulmonary shunt （Qs/Qt） were calculated.At T0,T4,T7 and 2 h and 24 h after operation （T9.10）,blood samples were collected from the internal jugular vein for determination of serum interleukin-6 （IL-6）,tumor necrosis factor-alpha （TNF-α） and IL-10 concentrations by enzyme-linked immunosorbent assay.Results Compared with group LR1,the OI was significantly increased,and Qs/Qt was significantly decreased at T6 in LR2 and LR4 groups （P〈0.05）,and no significant change was found in the parameters mentioned above in group LR3 （P〉0.05）.There was no significant difference in OI and Qs/ Qt at each time point between group LR2 and group LR4 （P〉0.05）.Compared with group LR1,the s

关 键 词：正压呼吸 呼吸功能试验 呼吸 人工 

分 类 号：R614[医药卫生—麻醉学]