无呼吸性气流通气联合60%吸入氧浓度对单肺通气手术患者的肺保护作用  

The lung-protective effects of apneic oxygen insufflation combined with 60%inhaled oxygen concentration on patients undergoing one-lung ventilation surgery

作　　者：高清贤 程雪淋 王青青 袁振飞[1] GAO Qingxian;CHENG Xuelin;WANG Qingqing;YUAN Zhenfei(Department of Anesthesiology,Nantong Rici Hospital,the Fouth Clinical Medical College of Yangzhou University,Nantong Rich Hospital,Nantong 226000,Jiangsu,China)

机构地区：[1]南通瑞慈医院扬州大学第四临床医学院麻醉科,南通226000

出　　处：《中国现代手术学杂志》2024年第5期404-410,共7页Chinese Journal of Modern Operative Surgery

基　　金：2022年度南通市卫生健康委员会科研课题(QNZ2022057)。

摘　　要：目的探讨无呼吸性气流通气(apneic oxygen insufflation,AOI)联合60%吸入氧浓度对单肺通气(one-lung ventilation,OLV)手术患者的肺保护作用。方法选取2022年1月~2023年3月在南通瑞慈医院扬州大学第四临床医学院进行胸腔镜下肺叶切除手术的40例患者,随机分为研究组(AOI+60%氧浓度)和对照组(AOI+纯氧),每组20例。对比两组OLV前(T0)、OLV后30 min(T1)、OLV后60 min(T2)、双肺通气10 min(T3)等4个时点的动脉氧合指数(oxygenation index,OI)、呼吸指数(respiratory index,RI)、肺动态顺应性(dynamic lung compliance,Cdyn)以及术后1 d及30 d的肺部并发症发生率。结果研究组患者氧合指数在T1、T2、T3时均高于对照组,且组别×测量时间交互效应差异显著(P<0.001)。研究组患者呼吸指数在T1、T2、T3时均低于对照组,且组别×测量时间交互效应差异显著(P<0.001)。研究组患者肺动态顺应性在T1、T2、T3时均高于对照组,但组别×测量时间交互效应差异不显著(P>0.05)。肺萎陷及手术视野暴露效果评分两组比较无明显统计学差异(P>0.05)。与对照组相比,研究组术后肺部并发症发生率较低,差异具有统计学意义(P<0.05)。结论胸腔镜下肺叶切除手术患者实施AOI联合60%吸入氧浓度有助于氧合功能的改善,以及降低肺部并发症的发生,可以保护肺功能。Objective To explore the lung-protective effects of apneic oxygen insufflation(AOI)combined with 60%inhaled oxygen concentration on patients undergoing one-lung ventilation(OLV)surgery.Methods Forty patients who underwent thoracoscopic lung lobectomy surgery at a hospital between March 2021 and June 2022 were randomly divided into a control group(AOI+pure oxygen)and an experimental group(AOI+60%oxygen concentration),with 20 patients in each group.Oxygenation index(OI),respiratory index(RI),dynamic lung compliance(Cdyn)and postoperative pulmonary complications were compared at four time points:before OLV(T0),30 minutes after OLV(T1),60 minutes after OLV(T2),and 10 minutes after bilateral ventilation(T3).Results The arterial oxygenation index of the experimental group was higher than that of the control group at T1,T2,and T3,and the interaction effect between groups and measurement time was significant(P<0.001).The respiratory index of the experimental group was lower than that of the control group at T1,T2,and T3,and the interaction effect between groups and measurement time was significant(P<0.001).The dynamic compliance of the experimental group was higher than that of the control group at T1,T2,and T3,but the interaction effect between groups and measurement time was not significant(P>0.05).There was no significant statistical difference in the scores of lung collapse and surgical field exposure between the two groups(P>0.05).Compared with the control group,the experimental group had fewer postoperative pulmonary complications(P<0.05).Conclusion The implementation of AOI combined with 60%inhaled oxygen concentration during OLV in patients undergoing thoracoscopic lung lobectomy surgery helps improve oxygenation and reduce the occurrence of pulmonary complications,thus protects lung function.

关 键 词：肺叶切除手术 单肺通气 吸入氧浓度 肺功能 

分 类 号：R61[医药卫生—外科学]