两种肺隔离技术对患者呼吸力学及血流动力学的影响  

Effects of two pulmonary isolation techniques on respiratory mechanics and hemodynamics in patients

作　　者：俞丹红 袁孝忠 周煦燕 李振平 赵俊杰 孔敏 姚明 YU Danhong;YUAN Xiaozhong;ZHOU Xuyan(Department of Anesthesiology,the First Hospital of Jiaxing,Jiaxing 314001,China)

机构地区：[1]嘉兴市第一医院麻醉与疼痛医学中心,314001 [2]嘉兴市第一医院胸外科,314001

出　　处：《浙江医学》2020年第9期932-934,952,共4页Zhejiang Medical Journal

基　　金：浙江省浙北麻醉学区域专病中心建设项目(浙卫发[2015]21号);2020年嘉兴市公益性研究计划(自筹经费)(2020AD30075);嘉兴市科技计划项目(民生科技创新专项)(2019AD32203)。

摘　　要：目的比较两种肺隔离技术(支气管封堵管与双腔支气管导管)对胸腔镜下肺叶切除术患者单肺通气时呼吸力学及血流动力学的影响。方法选取择期行胸腔镜下肺叶切除术(一叶肺切除术,左右不限)患者90例,采用随机数字表法分为采用支气管封堵管组(A组)和双腔支气管导管组(B组),各45例。监测两组患者侧卧位双肺通气10min、单肺通气10min、单肺通气30min 3个时点的心率(HR)、平均动脉压(MAP)、气道峰压(Peak)、呼气末二氧化碳分压(PETCO2)、动态肺顺应性(Cdyn)以及每搏量(SV)、心排量(CO)变化并进行分析比较。结果两组患者在侧卧位双肺通气10min时,各项指标差异均无统计学意义(均P>0.05);两组患者在单肺通气10min和30min时,A组患者Peak、PETCO2低于B组,Cdyn、SV和CO高于B组,在单肺通气10min时,A组HR低于B组,MAP高于B组,差异均有统计学意义(均P<0.05)。结论与双腔支气管导管相比,采用支气管封堵管进行单肺通气能有效降低Peak、增加健侧肺Cdyn,改善呼吸力学并能维持血流动力学稳定,且安全性较高,有利于患者快速康复。Objective To compare the effect of respiratory parameters and hemodynamics of bronchial occlusion with double lumen tube in single-lung ventilation patients undergoing thoracoscopic lobectomy.Methods Ninety patients undergoing selective thoracoscopic lobectomy were randomly divided into two groups with 45 patients in each group,Group A was treated with bronchial occlusion tube,while Group B was treated with double lumen tube.The heart rate(HR),mean arterial pressure(MAP),airway pressure(Peak),partial pressure of carbon dioxide(PETCO2),dynamic lung compliance(Cdyn),stroke volume(SV)and cardiac output(CO)were observed in the lateral position of double-lung ventilation for 10 min,one-lung ventilation for 10 min,one-lung ventilation for 30 min.Results In the two groups,there was no significant difference in each index during bilateral lateral ventilation(P>0.05).The peak and PetCo2 of group A were lower than those of group B at one-lung ventilation for 10 min and 30 min,while Cdyn,SV and CO were higher than those in group B,the HR of group A was lower than that of group B and the MAP of group A was higher than that of group B at one-lung ventilation for 10 min(P<0.05).Conclusion Compared with the double lumen tube,bronchial occluder can effectively reduce the airway platform pressure,increase the compliance of the contralateral lung,improve respiratory parameters and maintain the stability of emodynamics,which is more safe and more effective in accelerating patient's recovery.

关 键 词：胸腔手术 支气管封堵管 双腔支气管导管 呼吸力学 血流动力学 

分 类 号：R614[医药卫生—麻醉学]