超声评估反比通气对胸科术后膈肌功能的影响  

Ultrasound evaluation of the effect of inverse ratio ventilation on diaphragmatic function after thoracic surgery

作　　者：王娴雅 何林丹 丰嘉露 张邓新 Wang Xianya;He Lindan;Feng Jialu;Zhang Dengxin(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,the Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of Anesthesiology,the Affiliated Obstetrics and Gynecology Hospital of Jiangnan University,Wuxi 214125,China)

机构地区：[1]徐州医科大学麻醉学院,徐州221004 [2]江南大学附属医院麻醉科,无锡214122 [3]江南大学附属妇产医院麻醉科,无锡214125

出　　处：《国际麻醉学与复苏杂志》2024年第9期970-976,共7页International Journal of Anesthesiology and Resuscitation

基　　金：无锡市卫健委重大科研项目(Z202211)。

摘　　要：目的应用M型超声评价反比通气对胸科肺部手术术后膈肌功能的影响。方法选择择期行单侧单个肺叶切除术的患者86例,年龄18~65岁,18.5 kg/m^(2)<体重指数(BMI)<30.0 kg/m^(2),美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,采用随机数字表法将患者分为常规通气组(C组)、反比通气组(F组),每组43例。支气管插管全身麻醉后,双肺通气时潮气量(VT)6~8 ml/kg,呼吸频率(RR)12~15次/min,吸入氧浓度50%,吸入氧流量1 L/min;单肺通气时F组吸呼比(I∶E)=2∶1,VT 6 ml/kg,呼气末正压(PEEP)5 cmH2O(1 cmH_(2)O=0.098 kPa),C组I∶E=1∶2,两组患者其他呼吸参数一致。记录患者一般资料(年龄、性别比、BMI、ASA分级、高血压、糖尿病)。记录麻醉前(T_(0))、单肺通气后5 min(T_(1))、单肺通气后1 h(T_(2))、术毕即刻(T_(3))患者心率、平均动脉压(MAP)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2));记录T_(1)、T_(2)、T_(3)时的气道峰压(Ppeak)、气道平台压(Pplat)、平均气道压(Pmean)和PEEP;应用M型超声采集T_(0)和拔管后即刻(T_(4))的双侧膈肌移动度(DE)及膈肌浅快呼吸指数(D‑RSBI),记录住院时间、膈肌功能障碍及术后5 d肺部并发症发生情况,并对膈肌功能障碍与术后5 d肺部并发症发生情况进行Spear‑man相关性分析;记录手术时间、单肺通气时间、气管拔管时间;术毕拔管后记录警觉/镇静观察评分。结果与C组比较:F组T4时术侧及非术侧DE较高、D‑RSBI较低(均P<0.05);DE差值、D‑RSBI差值较低(均P<0.05);T_(1)、T_(2)时PaO_(2)较高(均P<0.05);T_(1)、T_(2)、T_(3)时Ppeak、Pplat较低(均P<0.05),PEEP、Pmean较高(均P<0.05)。与T0时比较,两组患者T4时术侧及非术侧DE降低、D‑RSBI升高(均P<0.05)。与术侧比较,两组患者T4时非术侧DE较高、D‑RSBI较低(均P<0.05),DE差值、D‑RSBI差值较低(均P<0.05)。Spearman相关性分析显示,膈肌功能障碍发生情况与术后5 d肺部并发症发生情况呈正相�Objective To evaluate the effect of inverse ratio ventilation on diaphragmatic function after thoracic lung surgery through M‑mode ultrasound.Methods A total of 86 patients,aged 18‒65 years,with body mass index(BMI)of 18.5 kg/m^(2) to 30.0 kg/m^(2),and American Society of Anesthesiologists(ASA)classification gradesⅠorⅡ,who were scheduled for unilateral single‑lung lobecto‑my,were selected.According to the random number table method,they were divided into two groups(n=43):a conventional ventilation group(group C)and an inverse ratio ventilation group(group F).After endotracheal intubation under general anesthesia,the tidal volume(VT)was set at 6‒8 ml/kg,respiratory rate(RR)at 12‒15 times/min,oxygen concentration at 50%,and oxygen flow at 1 L/min during double‑lung ventilation.For single‑lung ventilation,group F showed an inspiration‑to‑expiration ratio(I∶E)of 2∶1,with a VT of 6 ml/kg,and positive end‑expiratory pressure(PEEP)of 5 cmH2O(1 cmH2O=0.098 kPa),while group C had an I∶E ratio of 1∶2.Other respirato‑ry parameters were the same between the two groups.Then,record patient demographics(age,gender ratio,BMI,ASA classification,hy‑pertension,diabetes)and the heart rate,mean arterial pressure(MAP),arterial partial pressure of oxygen(PaO2),and arterial partial pressure of carbon dioxide(PaCO_(2))were recorded before anesthesia(T_(0)),5 min after single‑lung ventilation(T_(1)),1 h after single‑lung ventilation(T_(2)),and immediately after surgery(T_(3)).The airway peak pressure(Ppeak),plateau airway pressure(Pplat),mean airway pressure(Pmean),and PEEP were recorded at T_(1),T_(2),and T_(3).The M‑mode ultrasound was used to collect bilateral diaphragmatic ex‑cursion(DE)and diaphragmatic rapid shallow breathing index(D‑RSBI)at T_(0) and immediately after extubation(T_(4)).Hospital stay du‑ration,the incidence of diaphragmatic dysfunction and pulmonary complications within postoperative 5 d was recorded,and Spearman correlation analysis was conducted to evaluate the rel

关 键 词：膈肌 超声 术后肺部并发症 膈肌功能障碍 反比通气 

分 类 号：R614[医药卫生—麻醉学]