反比通气对肺叶切除婴儿单肺通气时肺功能的影响  

Effect of inverse ratio ventilation on pulmonary function in infants with pulmonry lobectomy during one lung ventilation

作　　者：王昀 李永乐[1] 方琴[1] 韩宝义 刘晶[1] 胡祖荣[1] WANG Yun;LI Yongle;FANG Qin;HAN Baoyi;LIU Jing;HU Zurong(Department of Anesthesiology,Guangdong Women and Children's Hospital,Guangdong Province,Guangzhou511400,China)

机构地区：[1]广东省妇幼保健院麻醉科,广东广州511400

出　　处：《中国医药导报》2020年第13期118-121,共4页China Medical Herald

基　　金：广东省省级科技计划项目(2017ZC0318);广东省医学科学技术研究基金项目(A2016173)。

摘　　要：目的探讨反比通气(IRV)对肺叶切除婴儿单肺通气(OLV)时肺通气和换气功能的影响。方法选择2017年10月~2018年10月于广东省妇幼保健院择期行胸腔镜下肺叶切除术患儿66例,采用随机数字表法分为反比通气组与常规通气组,每组33例。记录患儿双肺通气(TLV)15 min(T1)、OLV 30 min(T2)、OLV 60 min(T3)、恢复TLV 15 min(T4)的呼吸力学指标,并进行血气分析。结果两组患儿T2、T3时气道峰压(Ppeak)、平均气道压(Pmean)、动脉二氧化碳分压(PaCO2)、肺泡动脉氧分压差(PA-aO2)、呼吸指数(RI)、无效腔率(VD/VT)高于T1时,动态肺顺应性(Cdyn)、pH值、动脉血氧分压(PaO2)、氧合指数(OI)低于T1时,差异有统计学意义(P<0.05)。反比通气组T2、T3时Pmean、Cdyn、PaO2、OI高于常规通气组,Ppeak、PaCO2、PA-aO2、RI低于常规通气组,差异有统计学意义(P<0.05)。除Ppeak、pH值外,两组患儿各指标存在交互作用。两组患儿术后低氧血症比较,差异无统计学意义(P>0.05)。此外,两组患儿均未见苏醒延迟、肺不张和气胸等并发症。结论反比通气应用于胸腔镜下肺叶切除术的单肺通气患儿,在一定程度上能增加肺顺应性,降低Ppeak,改善肺弥散功能,促进氧合,安全可行。Objective To investigate the effect of inverse ratio ventilation(IRV)on pulmonary ventilation and exchange function in infants with pulmonary lobectomy during one lung ventilation(OLV).Methods A total of 66 infants of Guangdong Women and Children's Hospital with thoracoscopic lobectomy were selected from October 2017 to October 2018,while they were divided into the inverse ventilation group and the conventional ventilation group by random number table method,with 33 infants in each group.The respiratory mechanics indexes of the infants'threshold limit ventilation(TLV)15 min(T1),OLV 30 min(T2),OLV 60 min(T3),and recovery TLV 15 min(T4)were recorded,and blood gas analysis was performed.Results Peak airway pressure(Ppeak),mean airway pressure(Pmean),arterial carbon dioxide partial pressure(PaCO2),pulmonary alveolar arterial oxygen partial pressure difference(PA-aO2),respiratory index(RI),void rate(VD/VT)at T2 and T3 were higher than those at T1,while the dynamic lung compliance(Cdyn),pH,arterial blood oxygen partial pressure(PaO2),oxygenation index(OI)were lower than those at T1,and the differences were statistically significant(P<0.05).Pmean,Cdyn,PaO2,OI in the inverse ventilation group at T2 and T3 were higher than those in the conventional ventilation group,while Ppeak,PaCO2,PA-aO2,and RI were lower than those in the conventional ventilation group,and the differences were statistically significant(P<0.05).In addition to Ppeak and pH,there were interaction between other indicators of the two groups.There were no statistically significant difference in postoperative hypoxemia between the two groups(P>0.05).In addition,there was no complications such as delayed recovery,atelectasis and pneumothorax in the two groups.Conclusion IRV applied to infants with single lung ventilation under thoracoscope lobectomy can increase lung compliance,reduce Ppeak,improve lung diffusion function,and promote oxygenation to a certain extent.

关 键 词：反比通气 单肺通气 婴儿 肺功能 

分 类 号：R563.8[医药卫生—呼吸系统]