大容量肺灌洗术中精确调节肺通气量的影响  

Effect of precise regulated ventilation during whole-lung lavage

作　　者：闫书梅[1] 孙玉香[1] 肖新宇[1] 马国宣[1] 黄京慧[1] YAN Shu-mei;SUN Yu-xiaag;XIAO Xin-yu;MA Guo-xuan;HUANG Jing-hui(Pneumoconiosis Department,Beidaihe Occupational Disease Prevention and Control Institute,State Administration of Work Safety,Qinhuangdao Hebei,066100,China)

机构地区：[1]国家安全生产监督管理总局北戴河职业病防治院尘肺科,河北秦皇岛066100

出　　处：《职业与健康》2018年第15期2035-2038,共4页Occupation and Health

基　　金：十二五科技支撑课题(2014BAI12BO2)

摘　　要：目的探讨肺灌洗双肺通气期间精确调节灌洗侧肺通气量的有效性。方法选取120例双肺灌洗患者为研究对象,于第一侧肺灌洗结束双肺通气期间使用容量控制通气模式呼吸管理,潮气量为8~12 ml/kg,随机分成3组,每组40例。第1组不改变左右肺的通气量为不调节组;第2组使用止血钳减少一部分非灌洗侧肺通气的横截面积为粗略调节组;第3组在灌洗侧肺安装监护仪(Philips MP50)呼吸力学监测管,使用阀门(氧气袋流量阀门)逐渐减小非灌洗侧肺的横截面积,通过监护仪监测灌洗侧肺通气量达到预设潮气量的50%,即左右肺通气量相等,每隔5 min重新调节阀门为精确调节组。结果 (1)精确调节组与粗略调节组和不调节组比较,灌洗侧肺的顺应性、血氧饱和度(SPO2)、氧合指数均有提高;心率、平均动脉压等指标在灌洗后20、40、60 min 3个时间点均有下降,差异有统计学意义(P<0.05)。粗略调节组与不调节组比较灌洗侧肺的顺应性提高,平均动脉压指标在灌洗后60 min有下降,差异有统计学意义(P<0.05)。(2)达到第二侧肺灌洗条件时两侧肺灌洗间隔时间,精确调节组与粗略调节组及不调节组比较,粗略调节组与不调节组比较均有缩短,差异有统计学意义(P<0.05)。(3)术后肺不张发生率,不调节组为20.0%,粗略调节组为15.0%,而精确调节组为0;术后肺感染发生率,不调节组为22.5%,粗略调节组为15.0%,而精确调节组为0;差异均有统计学意义(P<0.05)。结论双肺通气期间使用阀门精确调节肺通气量加快了灌洗侧肺顺应性的恢复,缩短了手术时间,减少了术后并发症,是一种行之有效的方法。[Objective] To investigate the effect of precise regulated ventilation of lavage side lung during double whole-lung lavage. [ Methods] A total of 120 patients with double whole-lung lavage were selected as the research object, and were randomly divided into three groups, 40 cases in each group. The volume control ventilation mode was used during the two lung ventilation after the first lung lavaged, with tidal volume of 8-12 ml/kg. The first group did not change the ventilation of two lungs as the nonregulated group. The second group used a hemostatic forceps to reduce the cross-sectional area of the non-lavage side as the rough regulated group. The third group was the precise regulated group, which continuously reduced the cross-sectional area of the nonlavage side using a valve （oxygen bag flow valve）, the respiratory monitoring tube （Philips MPS0） was used to monitor the lavage side ventilation, and to adjust the valve every 5 minutes when the lavage side ventilation volume approximated the half amount of the presupposition tidal volume, that is, volume of left and right lung ventilation is equal. [ Results ] （1） Compared with the rough regulated group and non-regulated group, the compliance, blood oxygen saturation （SPO2） and oxygenation index of lavage side in the precise regulated group increased. The levels of heart rate, mean arterial pressure and other indicators decreased at 20, 40, 60 minutes after lavage, and the difference was statistically significant （P〈0.05）. The compliance of lavage side in rough regulated group was higher than that in the non-regulated group, mean arterial pressure decreased at 60 minutes after lavage, and the difference was statistically significant （P〈0.05）. （2）.The interval time reaching the second lung lavage in the precise regulated group was shortened than that in the rough regulated group and non-regulated group, while that in the rough regulated group was shortened than that in the non-regulated group, and the differences were statisticall

关 键 词：大容量肺灌洗 通气量 肺顺应性 并发症 

分 类 号：R155.3[医药卫生—营养与食品卫生学]