高频喷射通气治疗胸腔手术单肺通气期间低氧血症的临床观察  

作　　者：王义[1] 张莉[1] 王莉[1] 任元华 赵永军[1] 黄蓉 

机构地区：[1]四川省广元市第一人民医院麻醉科,四川广元628017

出　　处：《湖南中医药大学学报》2018年第A01期392-393,共2页Journal of Hunan University of Chinese Medicine

摘　　要：目的:探讨高频喷射通气治疗胸腔手术单肺通气期间低氧血症的临床效果。方法:收集2015年03月~2016年12月我院行开胸手术术中单肺通气患者资料,回顾分析其中发生低氧血症者的病历资料。所有患者采用静吸复合麻醉,常规置入支气管双腔管,使用电子支气管镜行支气管双腔管定位。手术中术侧肺开放,非术侧肺采用低潮气量(6ml/kg)加呼气末正压PEEP(6cmH2O)行容量控制机械通气。对术中发生低氧血症(SpO2低于94%)的患者给予术侧肺高频喷射通气治疗,若无改善则施行间断双肺通气。高频喷射通气频率280次/分,吸呼比1:4或1:5。检测高频通气前、高频喷射通气后15分钟和实施双肺通气后15分钟的动脉血气分析。结果:回顾胸腔手术实施单肺通气患者共计374例,其中42例发生低氧血症,发生率为11.2%。该42例低氧血症患者全部接受术侧肺高频喷射通气治疗,其中30例(71.4%)治疗有效,治疗后动脉血氧分压和血氧饱和度明显改善(P<0.01);12例效果欠佳,实施间断双肺通气完成手术。结论:术侧高频喷射通气能够有效改善开胸手术单肺通气期间低氧血症,可在临床上选择性应用,但对高频喷射通气的通气方式、频率、吸呼比、通气量等尚需进一步研究。Purpose:To evaluate the effect of high-Frequency jet ventilation in hypoxemia patients receiving thoracic surgery with one-lung ventilation.Methods:We reviewed the clinical data of thoracotomy with one-lung ventilation from March,2015 to November,2016 in the hospital,and the cases of hypoxemia were analyzed retrospectively.All the patients received intravenous-inhalation general anesthesia and double-lumen endotracheal intubation,which was located by electronic-bronchoscope.The operated lung was open in the procedure and volume-controled ventilation with low tidal volume(6ml/kg)and low PEEP(6cm H2O)was perfomed in the non-operated lung.The patients with hypoxemia(SpO2<94%)were treated with high frequency jet ventilation in the non-operated lung.intermittent bilateral ventilation was performed in case with refractory hypoxemia.The high frequency jet ventilation was perfomed with a frequency of 280/min,and an I/E ratio from 1:4 to 1:5.Arterial blood analysis was perfomed before and 15 minutes after the start of the high frequency jet ventilation or intermittent bilateral ventilation.Result:A totality of 374 patients was reviewed,of whom 42 cases suffered from hypoxemia,the incidence of hypoxemia was 11.2%.High frequency jet ventilation relieved hypoxemia in 30 patients,which was evidenced by arterial partial pressure of oxygen and oxygen saturation through arterial blood analysis(P<0.01).As for the rest 12 case,intermittent bilateral ventilation was perfomed during the operation.Conclusion:High frequency jet ventilation improves oxygenation in hypoxemia patients receiving thoracic surgery with one-lung ventilation,implying its worthful prospect in this specific patient population.Further studies are needed to comfirm its application mode,frequency,I:E ratio and ventilation volume.

关 键 词：胸腔手术 单肺通气 高频喷射通气 低氧血症 

分 类 号：R725.638[医药卫生—儿科]