小潮气量肺保护性通气策略在胸腔镜下行肺结核纤维板剥脱术患者的应用价值  

Application value of protective strategy of low tidal volume lung ventilation in patients undergoing pulmonary tuberculosis fiberboard exfoliation under thoracoscopy

作　　者：张维峰[1] 殷国平[1] 邓友明[1] 李玥豪 王佳[1] ZHANG Weifeng;YIN Guoping;DENG Youming(Department of Anesthesiology,Second Hospital of Nanjing,Nanjing 210003,CHINA)

机构地区：[1]南京市第二医院麻醉科,江苏210003

出　　处：《江苏医药》2022年第9期935-938,共4页Jiangsu Medical Journal

摘　　要：目的探讨小潮气量肺保护性通气策略在胸腔镜下行肺结核纤维板剥脱术患者的临床应用价值。方法将40例于胸腔镜下行肺结核纤维板剥脱术患者随机均分为观察组(S组)和对照组(C组);其中,C组实施常规肺通气,而S组在小潮气量肺通气基础上,术中每间隔30min实施保护性双肺通气。观察两组患者麻醉前(T0)、麻醉后双肺通气(T1)、在侧卧位下双肺通气15min(T2)、单肺通气后30min(T3)、恢复双肺通气后15min(T4)和术后2h(T5)时的SBP、DBP、HR、SpO_(2)及脑电双频指数(BIS);记录T1~T4时气道峰压(Ppeak)、气道阻力(Raw)以及T0、T2~T4和术后1d(T6)时的PaO_(2)、PaCO_(2)和pH值;观察术后肺不张、肺顺应性降低和通气/血流比值(VA/Q)失调的发生率。结果两组间T0~T5时SBP、DBP、HR、SpO_(2)及BIS比较差异均无统计学意义(P>0.05)。与T0时相比,两组T2、T3时PaCO_(2)升高,T2~T4时PaO_(2)升高(P<0.05);S组T2、T3时PaCO_(2)低于C组,而T2~T4时PaO_(2)高于C组(P<0.05)。与T1时相比,两组T2、T3时Ppeak和Raw升高(P<0.05),且C组升高更加明显(P<0.05)。S组肺不张、肺顺应性降低和VA/Q失调的发生率低于C组(P<0.05)。结论肺结核纤维板剥脱术患者术中应用小潮气量肺保护性通气策略可有效减轻单肺通气期间肺损伤程度,改善肺功能,减少术后并发症发生。Objective To investigate the clinical application value of protective strategy of low tidal volume lung ventilation in the patients undergoing pulmonary tuberculosis fiberboard exfoliation under thoracoscopy.Methods Forty patients undergoing pulmonary tuberculosis fiberboard exfoliation under thoracoscopy were equally randomized into two groups of S and C.The patients in group C accepted conventional lung ventilation,while whose in group S received protective two-lung ventilation every 30minutes on the basis of low tidal volume lung ventilation.The changes of SBP,DBP,HR,SpO_(2)and BIS were recorded before anesthesia(T0),immediately after anesthesia with two-lung ventilation(T1),in the lateral position with two-lung ventilation for 15minutes(T2),30minutes after one-lung ventilation(T3),15 minutes after recovery of two-lung ventilation(T4)and 2hours after operation(T5)in both groups.The airway peak pressure(Ppeak)and airway resistance(Raw)at T1-T4and the PaO_(2),PaCO_(2)and pH value at T0,T2-T4and one day after operation(T6)were recorded.The incidences of pulmonary atelectasis,reduced pulmonary compliance and imbalance of VA/Q ratio were calculated after operation.Results There were no statistical differences in SBP,DBP,HR,SpO_(2)and BIS between groups of S and C at T0-T5(P>0.05).Compared with T0,the PaCO_(2) was increased at T2and T3,and PaO_(2)was increased at T2-T4in both groups(P<0.05).The PaCO_(2)at T2and T3was lower,while PaO_(2)at T2-T4was higher in group S than those in group C(P<0.05).Compared with T1,the Ppeak and Raw at T2and T3 were increased in both groups(P<0.05),while which were higher in group C than those in group S(P<0.05).The incidences of pulmonary atelectasis,reduced pulmonary compliance and imbalance of VA/Q ratio in group S were lower than those in group C(P<0.05).Conclusion The intraoperative application of protective strategy of low tidal volume lung ventilation in the patients undergoing pulmonary tuberculosis fiberboard exfoliation may effectively reduce the lung injury during one-lung ve

关 键 词：肺结核 纤维板剥脱术 小潮气量 肺保护性通气策略 

分 类 号：R521[医药卫生—内科学]