驱动压指导通气策略对婴儿胸腔镜手术单肺通气时脑部氧合的影响  

Effect of driving pressure guided ventilation strategy on cerebral oxygen saturation in infants with one lung ventilation during thoracoscopic surgery

作　　者：黄符香 李海洋[2] 漆冬梅[2] 黄伟坚[2] HUANG Fuxiang;LI Haiyang;QI Dongmei;HUANG Weijian(Department of Anesthesiology,Danzhou's People Hospital,Danzhou 571700,ChinaCorresponding;不详)

机构地区：[1]儋州市人民医院麻醉科,海南儋州571700 [2]广东省妇幼保健院麻醉科,广州510180

出　　处：《实用医学杂志》2023年第19期2501-2505,共5页The Journal of Practical Medicine

基　　金：广东省医学科研基金项目(编号:202011192072927)。

摘　　要：目的观察驱动压(DP)指导通气策略对婴儿胸腔镜手术单肺通气(OLV)时脑氧饱和度(S_(rc)O_(2))的影响。方法60例择期胸腔镜手术婴儿随机分成对照组(C组)和驱动压力组(DP组),每组30例。通过近红外光谱仪监测S_(rc)O_(2),以S_(rc)O_(2)较基线下降>20%为低脑氧合(COD)。记录OLV期间低血压发生率、通气补救次数、COD发生率及其持续时间。比较两组婴儿胸人工气胸前(T_(1))、人工气胸后30 min(T_(2))和人工气胸后60 min(T_(3))的MAP、HR、S_(rc)O_(2)、P_(EEP)、气道峰压(P_(peak)),肺静态顺应性(C_(s)),以及人工气胸前后的动脉血气分析结果。结果两组在S_(rc)O_(2)基线、OLV时S_(rc)O_(2)平均值、低血压发生率、COD发生率上均差异无统计学意义(P>0.05)。DP组通气补救次数和COD持续时间均低于C组(P<0.05)。两组患儿在T_(1)时的MAP、HR、S_(rc)O_(2)、P_(peak)、C_(s)、P_(a)O_(2)和OI均差异无统计学意义(P>0.05)。与T_(1)相比,两组患儿在T_(2)和T_(3)时P_(peak)均升高,S_(rc)O_(2)和C_(s)降低(P<0.05)。与C组相比,DP组在T_(2)时P_(a)O_(2)和OI更高,T_(2)和T_(3)时P_(peak)更低,P_(EEP)和C_(s)更高(P<0.05)。DP组患儿气管拔管时间和PACU停留时间短于C组(P<0.05)。两组患儿苏醒延迟、二次气管插管和术后躁动的发生率差异均无统计学意义(P>0.05)。结论DP通气策略可改善通气侧肺部顺应性,提高婴儿OLV时的氧合水平,缩短COD暴露时间。Objective To investigate the effect of driving pressure(DP)guided ventilation strategy on regional cerebral oxygen saturation(S_(rc)O_(2))in infants with one lung ventilation(OLV)during thoracoscopic surgery.Methods Sixty infants undergoing elective thoracoscopic surgery were randomly divided into control group(group C,n=30)and driving pressure group(group DP,n=30).Near-infrared spectroscopy was used to monitor S_(rc)O_(2)during OLV.Cerebral oxygen desaturation(COD)was defined as S_(rc)O_(2)decreased by more than 20%from baseline.The incidence of hypotension,time of ventilation rescue,the incidence of COD and its duration during OLV were recorded.MAP,HR,S_(rc)O_(2),P_(EEP),airway peak pressure(Ppeak),static lung compliance(Cs)were recorded before(T_(1)),30 min after(T_(2))and 60 min after(T_(3))artificial pneumothorax,and results of arterial blood gas analysis on T_(1)and were T_(2)compared.Results There were no significant differences in the S_(rc)O_(2)baseline,the mean S_(rc)O_(2)during OLV,the incidence of hypotension and the incidence of COD between the two groups(P>0.05).Times of ventilation rescue and COD duration in DP group were lower than those in C group(P<0.05).There were no significant differences in MAP,HR,S_(rc)O_(2),Ppeak,Cs,PaO_(2)and OI between the two groups at T_(1)(P>0.05).Compared with T_(1),Ppeak increased and S_(rc)O_(2)and Cs decreased in both groups at T_(2)and T_(3)(P<0.05).Compared with group C,group DP had higher PaO_(2)and OI at T_(2),lower Ppeak and higher P_(EEP)and Cs at T_(2)and T_(3)(P<0.05).Conclusion DP guided ventilation strategy improved lung compliance,increased oxygen saturation and shortened the exposure of COD in infants during OLV.

关 键 词：驱动压 脑氧饱和度 单肺通气 婴儿 胸腔镜手术 

分 类 号：R614[医药卫生—麻醉学]