国际麻醉学与复苏杂志   2017, Issue (10): 0-0
    
肺复张策略对健侧肺氧合及顺应性的影响
石博, 张新敏, 吴楠, 王馥婧, 董乃夫, 麻海春1()
1.吉林大学第一医院
The effect of lung recruitment maneuvers on arterial oxygenation and dynamic compliance in lungs on un-operated side
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摘要:

目的 评价肺复张策略(lung recruitment maneuvers, LRM)对健侧肺氧合及顺应性的影响。 方法 ASA分级Ⅱ级择期行胸腔镜辅助下肺切除术患者40例,采用随机数字表法分为对照组(C组)和实验组(L组),每组20例。C组术中常规单肺通气(one lung ventilation, OLV),L组OLV 20 min后进行1次LRM,两组均在OLV结束关闭胸腔前进行1次肺复张。分别于患者麻醉前(T0),OLV后20 min(T1),LRM后15 min(T2)、30 min(T3)、45 min(T4)及OLV结束(T5)时,采集患者生命体征数据并采集动脉血样本进行血气分析,根据公式计算肺顺应性(dynamic compliance, Cdyn)。 结果 与C组相比,L组PaO2在T2[(150±11) mmHg比(204±21) mmHg,1 mmHg=0.133 kPa]、T3[(154±12) mmHg比(176±14) mmHg]、T5[(442±20) mmHg比(473±15) mmHg]时点均升高(P<0.05),Cdyn在T2[(21±3) ml/cmH2O比(25±3) ml/cmH2O,1 cmH2O=0.098 kPa]和T5[(26±3) ml/cmH2O比(31±5)ml/cmH2O)]时点提高(P<0.05)。 结论 LRM可以有效改善OLV期间氧合及Cdyn,单次LRM提高PaO2有效时间为30 min,在15 min左右PaO2改善最为明显。

关键词: 单肺通气; 低氧血症; 肺顺应性; 呼气末正压通气
Abstract:

Objective To evaluate the effect of lung recruitment maneuvers(LRM) on arterial oxygenation and dynamic compliance in lungs on un-operated side. Methods Forty patients, of ASA physical status Ⅱ, scheduled for selective thoracoscope-assisted pulmonary resection, were randomly divided in to 2 groups(n=20): Control group (group C) and LRM group (group L). After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated. After correct positioning was confirmed by fiberoptic bronchoscopy, one lung ventilation(OLV) was performed instead. OLV was performed routinely in group C. In group L, the same ventilator pattern was set as group C, do LRM once after 20 min of OLV. Both groups are applied LRM before closure of thorax. Vital signs and artery blood samples were recorded at baseline(T0), 20 min after OLV(T1), 15 min(T2), 30 min(T3), 45 min(T4) after LRM respectively, and the end of OLV(T5). Dynamic compliance(Cdyn) was calculated. Results Compared with group C, the PaO2 was significantly higher at T2[(150±11) mmHg vs (204±21) mmHg,1 mmHg=0.133 kPa], T3[(154±12) mmHg vs (176±14) mmHg], T5[(442±20) mmHg vs (473±15) mmHg], Cdyn is better at T2 [(21±3) ml/cmH2O vs (25±3) ml/cmH2O,1 cmH2O=0.098 kPa] and T5[(26±3) ml/cmH2O vs (31±5) ml/cmH2O] in group L. Conclusions LRM can improve arterial oxygenation and Cdyn in lungs on no operated side. The duration of one LRM is about 30 min, the improvement of PaO2 is distinct around 15 min after LRM.

Key words: One lung ventilation; Hypoxemia; Dynamic compliance; Positive end-expiratory pressure