支气管封堵器下肺叶隔离在胸腔镜手术中对每搏量变异度及低氧血症的影响  

Analysis of the effect of lobar sequestration under bronchial occluder on stroke volume variability and hypoxemia during thoracoscopic surgery

作　　者：魏丽青 王永强 侯学玲 WEI Li-qing;WANG Yong-qiang;HOU Xue—ling(Department of Anesthesiolo­gy,Zhejiang Xinan International Hospital,Jiaxing 314300,Zhejiang,China;不详)

机构地区：[1]浙江新安国际医院麻醉科,浙江嘉兴314300 [2]中国石油天然气集团公司中心医院检验科,河北廊坊065000

出　　处：《广东医学》2020年第22期2298-2302,共5页Guangdong Medical Journal

基　　金：廊坊市科学技术研究与发展计划(第一批)自筹经费项目(2018013080)。

摘　　要：目的探析支气管封堵器下肺叶隔离在胸腔镜手术中对每搏量变异度及低氧血症的影响。方法选取院内82例行胸腔镜手术合并支气管封堵管通气治疗的患者,按随机数字表法均分为A、B两组,各41例患者。A组行支气管封堵器法肺隔离单肺通气技术,B组行支气管封堵器法选择性肺叶隔离通气,观察两组目标肺萎缩及手术视野暴露情况、各时间节点[麻醉后通气前(T0)、平卧位麻醉后双肺通气10min(T1)、改变体位至侧卧位再双肺通气10min(T2)、支气管封堵器肺隔离单肺通气或选择性肺叶隔离通气10 min(T3)、手术结束前双肺通气10min(T4)]的每搏量变异度及血气分析情况。结果两组患者目标肺萎缩及手术视野暴露均达到预期目标效果,优良率为100.00%,两组比较差异无统计学意义(P>0.05)。两组患者收缩压(SBP)、舒张压(DBP)、心排血量(CO)以及每搏输出量(SV)值在各时间节点间比较差异均无统计学意义(P>0.05)。两组患者T3时SBP、DBP值显著高于本组T1时(P<0.05);B组T4时每搏量变异度(SVV)值显著高于A组(P<0.05);两组患者各时间节点PaCO2水平组间比较差异无统计学意义(P>0.05)。B组T1、T2、T3的PaO2水平均显著高于A组(P<0.05);B组T1、T2、T3的Qs/Qt值均显著低于A组(P<0.05)。结论支气管封堵器下选择性肺叶隔离可显著减少胸腔镜手术患者的肺内分流量,提高氧分压,降低术中低氧血症的发生率,且SVV值高,值得临床应用。Objective To investigate the effect of lobar sequestration under bronchial occluder on stroke volume variability and hypoxemia during thoracoscopic surgery. Methods A total of 82 patients who received thoracoscopic surgery combined with bronchial occlusion ventilation were randomly divided into Group A and B(n=41). Group A received bronchial occlusive single-lung ventilation, while Group B received occlusive ventilation. The target lung atrophy, exposure of surgical field, variability of stroke volume and blood gas analysis at each time node(T0, T1, T2, T3 and T4) were observed. Results The target pulmonary atrophy and surgical field exposure of the two groups reached the expected target effect, the excellent and good rate was 100.00%. There was no significant difference in SBP, DBP, CO and SV between the two groups at each time point(P>0.05). SBP and DBP values at T3 in two groups were significantly higher than those at T1(P<0.05). The SVV value of Group B at T4 was significantly higher than that of Group A(P<0.05). There was no significant difference in PaCO2 level between the two groups at each time point(P>0.05). The PaO2 levels at T1, T2 and T3 in Group B were significantly higher than those in Group A(P<0.05). The Qs/Qt values at T1, T2 and T3 in Group B were significantly lower than those in Group A(P<0.05). Conclusion Selective lobar sequestration with bronchial occluder can significantly reduce intrapulmonary shunt volume, increase oxygen partial pressure and reduce the incidence of intraoperative hypoxemia in patients undergoing thoracoscopic surgery;and the SVV value is high, which is worthy of clinical application.

关 键 词：胸腔镜手术 支气管封堵器 肺叶隔离 每搏量变异度 低氧血症 

分 类 号：R616.2[医药卫生—外科学] R619.3[医药卫生—临床医学]