不同吸入气体对胸腔镜手术单肺通气影响的临床观察  

Clinical observation of the influence of different inhaled gases on one lung ventilation during thoracoscopic surgery

作　　者：汪润[1] 乔辉[1] 刘鹏飞[1] WANG Run;QIAO Hui;LIU Peng-fei(Department of Anesthesiology,Bejing Shijitan Hospital Affiliated to Capit Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院麻醉科,北京100038

出　　处：《广东医学》2023年第5期631-635,共5页Guangdong Medical Journal

摘　　要：目的 探讨不同吸入气体对胸腔镜手术肺萎陷和血流动力学的影响。方法 纳入研究对象为美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,择期全身麻醉下行胸腔镜肺部肿瘤切除术的患者60例,随机分为A组(n=20)、B组(n=20)和C组(n=20),3组从气管插管后至单肺通气前分别吸入空气/氧气混合气体(吸入氧浓度FiO_(2)=0.4)、氧化亚氮/氧气混合气体(FiO_(2)=0.4)、纯氧气(FiO_(2)=1.0)。单肺通气后3组均改为吸入50%氧气。记录时间点为切开胸膜后1 min(T0)、单肺通气开始后10 min(T1)、20 min(T2)、30 min(T3)。在各时间点记录LCS肺萎陷评分和Campos肺萎陷分级,测量血气,记录动脉血氧分压、平均动脉压和心率。结果 T0和T3时3组患者LCS评分及Campos评级差异无统计学意义(P>0.05),T1和T2时B组最高,C组次之,A组最低(P<0.05)。C组的动脉氧分压在T0及T1时高于A、B组(P<0.05),T2及T3时3组差异无统计学意义(P>0.05)。平均动脉压和心率3组间差异无统计学意义(P>0.05)。结论 患者术中行单肺通气前吸入氧化亚氮/氧气混合气体,单肺通气后肺萎陷能够达到更好的效果,对血流动力学没有不良影响。本研究通过延长肺萎陷及血流动力学指标的观测时间,为单肺通气麻醉中氧化亚氮的安全使用提供一定的指导和帮助。Objective To investigate the effects of different inhaled gases on pulmonary collapse and hemodynamics during thoracoscopic surgery.Methods The study included 60 patients of American Society of Anesthesiologists(ASA)Grade Ⅰ-Ⅱ who underwent elective thoracoscopic pulmonary tumor resection under general anesthesia.They were randomly divided into Group A(n=20),Group B(n=20),and Group C(n=20).All three groups were given with different gas mixtures from endotracheal intubation to single-lung ventilation,including air/oxygen mixture(inhaled oxygen concentration Fi0,=0.4),nitrous oxide/oxygen mixture(Fi0,=0.4),and pure oxygen(Fi0,=1.0).After single-lung ventilation,all three groups were switched to inhaling 50%oxygen.The recorded time points were 1 minute after pleural incision(T0),10 minutes(T1),20 minutes(T2),and 30 minutes(T3)after single-lung ventilation started.The LSC pulmonary collapse score and Campos pulmonary collapse grade were recorded at each time point,blood gas was measured,and arterial oxygen pressure,oxygen saturation,mean arterial pressure,and heart rate were recorded.Results There was no significant difference in the LSC score and Campos grade among the three groups at TO and T3.At TI and T2,Group B had the highest score,followed by Group C,and Group A had the lowest score(P<0.05).The arterial oxygen pressure of Group C was significantly higher than that of Groups A and B at TO and T1(P<0.05),but there was no significant difference among the three groups at T2 and T3.There was no significant difference in oxygen saturation,mean arterial pressure,and heart rate among the three groups.Conclusion Inhaling nitrous oxide/oxygen mixture before single-lung ventilation can achieve better lung collapse during surgery without adverse effects on hemodynamics.This study provides some guidance and help for the safe use of nitrous oxide in single-lung ventilation anesthesia by extending the observation time of pulmonary collapse and hemodynamic indicators.

关 键 词：胸腔镜 肺萎陷 单肺通气 吸入气体 动脉血氧 

分 类 号：R614.2[医药卫生—麻醉学] R614.21[医药卫生—外科学]