允许性高碳酸血症策略在婴儿单肺通气中的肺保护作用  

Protective effect of permissive hypercapnia in infants undergoing one-lung ventilation

作　　者：李永乐[1] 罗辉[1] 黄微 李海洋[1] 蔡明阳[1] 黎昆伟[1] 胡祖荣[1] 刘晶[1] LI Yongle, LUO Hui, HUANG Wei, LI Haiyang, CAI Mingyang, LI Kunwei, HU Zurong, LIU Jing.(Guangdong Women and Children＇s Hospital, Guangzhou 510010, Chin)

机构地区：[1]广东省妇幼保健院,广州510010

出　　处：《实用医学杂志》2018年第5期734-737,741,共5页The Journal of Practical Medicine

基　　金：广东省省级科技计划项目(编号:2016A020215127);广东省医学科学技术研究基金项目(编号:A2016173)

摘　　要：目的探讨允许性高碳酸血症通气策略在婴儿单肺通气中的肺保护作用。方法择期胸腔镜肺切除婴儿64例,随机分为正常碳酸血症组(N组)和高碳酸血症组(H组),每组32例。记录患儿气管插管后10 min(T_1),人工气胸后30 min(T_2)和60 min(T_3),以及术后30 min(T_4)4个时间点的一般生命体征和呼吸通气参数,并同时行动脉血气分析,利用公式计算氧合指数。于术前和术后行支气管灌洗,并收集支气管灌洗液,检测晚期糖基化终末产物受体(RAGE)的表达水平。结果与T_1相比,两组患儿于T_2和T_3时Ppeak均明显升高(P<0.05),PaO_2明显下降(P<0.05)。N组于T_2和T_3时MAP较T_1时降低(P<0.05),H组T_2和T_3时HR和PaCO_2较T_1时升高(P<0.05),而pH值以及Lac则明显降低(P<0.05)。与N组相比,H组于T_2和T_3时MAP、HR以及PaCO_2较N组明显升高(P<0.05),而P_(peak)、Vt、MVV、pH值以及Lac则明显降低(P<0.05)。两组患儿术后RAGE较术前明显增高(P<0.05)。与N组相比,H组RAGE表达水平较低(P<0.05)。结论婴儿实施OLV时采用PHC策略可在保证氧合的同时,有效改善组织氧合,并且有一定的肺保护意义。Objective To investigate the protective effect of permissive hypercapnia in infants undergoing one-lung ventilation （OLV）. Methods A total of 64 infants were randomly divided into Group N （normocapnia group, n = 32 ） and Group H （hypercapnia group, n = 32 ）. Arterial blood gas samples were collected at four differ- ent time points： 10 minutes after intubation （T1） , 30 and 60 minutes after artificial pneumothorax （T2., T3） , and 30 minutes after being sent to post anesthesia care unit （T4） while vital signs （HR, MAP, SpO2 and temperature） and ventilation parameters （Ppo.k, V,, PEEP, RR, MVV, and FiO2） were recorded simultaneously; O1 was calcu- lated by corresponding equation. Bronehoalveolar lavage fluid （BALF） was collected before and after surgetz~ for the measurement of RAGE. Results Compared with those at T,, MAP and PaO2 were significantly lower but P,,..k was obviously higher in group N, while HR, P,,,.k as well as PaCO： were increased （P 〈 0.05 ） and V,, MVV, pH, PaO2 as well as lactic acid were decreased in group H （P 〈 0.05 ） at T2 and T3. Compared with those in group N, MAP, HR as well as PaCO： were higher while P,,..k, Vt, MVV, pH, and lactic acid were lower in group H at T2 and T3 （P 〈 0.05 ）. There was a significant increase of RAGE in both groups after surgery and it was much higher in group N when compared with that in group H after surgery （P 〈 0.05 ）. Conclusion PHC not only has advantages in improving tissue oxygenation, but also has the potential of lung protection for infants undergoing OLV.

关 键 词：允许性高碳酸血症 单肺通气 婴儿 肺保护 氧合 

分 类 号：R726.1[医药卫生—儿科]