单肺通气期间无呼吸性气流通气联合低吸入氧浓度对老年患者氧合和术后肺部并发症的影响  

Effects of apneic oxygen insufflation combined with low inspired fraction of oxygen on oxygenation and postoperative pulmonary complications in elderly patients undergoing one-lung ventilation

作　　者：高蓓 高巨[1] 葛亚丽[1] GAO Bei;GAO Ju;GE Yali(Department of Anesthesiology,Northern Jiangsu People's Hospital,Yangzhou 225001,CHINA)

机构地区：[1]江苏省苏北人民医院麻醉科,江苏扬州225001

出　　处：《江苏医药》2024年第6期547-549,553,共4页Jiangsu Medical Journal

基　　金：国家自然科学基金(82172190)。

摘　　要：目的探讨单肺通气期间无呼吸性气流通气(AOI)联合低吸入氧浓度(FiO_(2))对老年患者氧合及术后肺部并发症的影响。方法90例行择期胸腔镜下肺癌根治术的老年患者随机分为三组,每组30例。C组常规单肺通气期间通气侧FiO_(2)为100%,非通气侧与大气相通;A组单肺通气期间通气侧FiO_(2)为100%,非通气侧实施AOI;B组单肺通气期间通气侧FiO_(2)为60%,非通气侧实施AOI。记录三组患者一般资料、手术指标、术后临床肺部感染评分(CPIS)及术后7d内肺部相关并发症发生情况。比较三组患者单肺通气前1min(T0)、单肺通气实施45min(T1)、单肺通气结束后30min(T2)时氧合指数(OI)和肺内分流率(Qs/Qt)。结果与T0时比较,T1时三组OI降低,Qs/Qt升高(P<0.05);与T1时比较,T2时三组OI升高,Qs/Qt降低(P<0.05)。A、B组T1、T2时OI高于C组,Qs/Qt低于C组(P<0.05)。B组患者术后CPIS、肺部并发症发生率低于A、C组(P<0.05)。结论单肺通气期间AOI联合低FiO_(2)可改善老年患者氧合,降低术后肺部并发症发生率。Objective To explore the effects of apneic oxygen insufflation(AOI)combined with low inspired fraction of oxygen(FiO_(2))on the oxygenation and postoperative pulmonary complications in elderly patients undergoing one-lung ventilation(OLV).Methods A total of 90 elderly patients undergoing elective thoracoscopic radical surgery for lung cancer under OLV were randomly divided into three groups with 30 cases each.The patients in group C had 100%FiO_(2)on the ventilated side lung during OLV,while the non-ventilated side lung was kept to open to the atmosphere.The patients in group A had 100%FiO_(2)on the ventilated side during OLV,while AOI was performed on the non-ventilated side.The patients in group B had 60%FiO_(2)on the ventilated side during OLV,while AOI was implemented on the non-ventilated side.The general information,surgery indicators,postoperative clinical pulmonary infection score(CPIS)and pulmonary-related complications within 7 days after surgery were recorded.The oxygenation index(OI)and intrapulmonary shunt rate(Qs/Qt)at 1 minute before OLV(T0),45 minutes during OLV(T1)and 30 minutes after OLV(T2)were compared among the three groups.Results Compared with T0,OI was decreased and Qs/Qt was increased in the three groups at T1(P<0.05).Compared with T1,OI was increased and Qs/Qt was decreased in the three groups at T2(P<0.05).At T1 and T2,OI in groups of A and B was higher than that in group C,while Qs/Qt was lower than that in group C(P<o.05).The postoperative CPIS and the incidence of pulmonary complications in group B was lower than those in groups of A and C(P<0.05).Conclusion AOI combined with low FiO_(2) can improve the oxygenation and reduce the incidence of postoperative pulmonary complications in elderly patients undergoing OLV.

关 键 词：单肺通气 无呼吸性气流通气 吸入氧浓度 氧合指数 

分 类 号：R614[医药卫生—麻醉学]