肺保护通气策略在右胸入路胸腔镜胸腺切除术中的应用效果  

Application of lung protective ventilation strategy in thoracoscopic thymectomy via right thoracic approach

作　　者：陈何伟 杨艳超[1] 潘晓伟 潘祖林 陈艺匀 CHEN Hewei;YANG Yanchao;PAN Xiaowei(Department of Anesthesiology,The First Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第一医院麻醉科 [2]河北省石家庄市第一医院妇科,050011 [3]河北省石家庄市第一医院胸腺外科,050011 [4]南方医科大学卫生管理学院

出　　处：《河北医药》2020年第17期2644-2646,2650,共4页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展计划项目(编号:181201063)。

摘　　要：目的分析肺保护通气策略在右胸入路胸腔镜胸腺切除术中的应用效果。方法选择2017年1~6月行右胸入路胸腔镜胸腺切除术的重症肌无力(MG)患者40例,患者随机分为肺保护组(PV组)和常规通气组(CV组),每组20例。2组患者术中均插入双腔气管导管,PV组患者单肺通气(OLV)时采用肺保护通气策略干预,潮气量(VT)6 ml/kg+呼气末正压通气(PEEP)5 cm H 2O+手法肺复张+限制气道平台压(Pplat)≤30 cm H 2O。CV组患者术中采用标准潮气量(VT)10 ml/kg,术中根据患者呼末二氧化碳和血气数值调整呼吸频率。分别于TLV通气5 min(T1),OLV通气30 min(T2)、OLV通气60 min(T3)、OLV结束后10 min(T4),抽取动脉血进行血气分析,根据肺泡-动脉氧分压差(A-aDO 2)数值,用公式计算呼吸指数(RI),监测记录气道峰压(Pmax),并根据公式计算出肺动态顺应性(Cdyn),同时记录计算低氧血症(SpO 2≤92%)的例数及发生率。结果T1、T4时点,2组pH值、PaCO 2、PO 2、A-aDO 2和RI比较差异无统计学意义(P>0.05)。T2、T3时点,与CV组比较,2组pH值均降低,PV组略低于CV组(P>0.05)。PV组PaCO 2、PO 2均高于CV组(P<0.05),A-aDO 2、RI均低于CV组(P<0.05)。PV组Pmax低于CV组,Cdyn高于CV组,呼吸频率(f)高于CV组,P ET CO 2高于CV组,低氧血症的例数及发生率低于CV组,2组比较差异有统计学意义(P<0.05)。结论在右胸入路胸腔镜胸腺切除术中应用肺保护通气策略,可提升脉搏血氧饱和度,减轻肺内分流,改善肺动态顺应性,同时避免气道压力过高造成肺损伤。Objective To investigate the application effects of lung protective ventilation strategy in thoracoscopic thymectomy via right thoracic approach.Methods A total of 40 patients with myasthenia gravis(MG)who underwent thoracoscopic thymectomy via right thoracic approach in our hospital from January to June 2017 were enrolled in the study,who were randomly divided into pulmonary protection group(PV group)and conventional ventilation group(CV group),with 20 cases in each group.The patients in PV group were intervened by lung protective ventilation strategy during one lung ventilation(OLV).The tidal volume(VT)was 6ml/kg+peep 5cmH 2O+manual lung re expansion+Pplat≤30cmH 2O.In CV group,the standard tidal volume(VT)was 10ml/kg,and the respiratory rate was adjusted according to the end expiratory carbon dioxide and blood gas.The arterial blood specimens were collected for blood gas analysis at 5 min(T1)of TLV,30 min(T2)of OLV,60min(T3)of OLV,and 10min(T4)after the end of OLV.According to the value of A-aDO 2,the respiratory index(RI)were observed,and the peak airway pressure(Pmax)was monitored,and the dynamic lung compliance(cdyn)was calculated according to formula,and the number of patients and incidence of hypoxemia(SpO 2≤92%)were observed and compared between the two groups.Results There were no significant differences in the levels of pH,PaCO 2,PO 2,A-aDO 2 and RI at T1 and T4 between the two groups(P>0.05).The levels of pH at T2 and T3 in PV group were slightly lower than those in CV group(P>0.05),however,the levels of PaCO 2 and PO 2 in PV group were significantly higher than those in CV group(P<0.05),however,the levels of A-aDO 2 and RI were significantly lower than those in CV group(P<0.05).Moreover the Pmax in CV group was significantly lower than CV group,and cdyn was significantly higher than CV group,respiratory frequency(f)was significantly higher than CV group,and PetCO 2 was significantly higher than CV group,and the number of patients and incidence of hypoxemia were significantly lower than CV group(P<

关 键 词：血气 肺泡-动脉氧分压差 呼吸指数 气道压 肺动态顺应性 

分 类 号：R971.1[医药卫生—药品]