国际麻醉学与复苏杂志   2018, Issue (10): 9-9
    
不同吸入氧浓度对胸腔镜手术肺萎陷及术后恢复的 影响
张梦, 董有静, 韩念娇, 韩寒1()
1.盛京医院麻醉科
The effects of different inspired oxygen concentration on the pulmonary collapse and postoperative recovery of thoracoscopic surgery
 全文:
摘要:

目的 探讨不同吸入氧浓度(fraction of inspired oxygen, FiO2)对胸腔镜手术肺萎陷及术后恢复的影响。 方法 择期行胸腔镜下肺癌根治术的患者,采用随机数字表法为A组(29例)和B组(30例),A组自麻醉诱导至单肺通气(one lung ventilation, OLV)前吸入50%氧气,B组自麻醉诱导至OLV前吸入100%氧气,OLV后两组均吸入50%氧气。于开胸膜后1 min(T0)及OLV开始后10 min(T1)、20 min(T2)、30 min(T3)时使用肺萎陷评分以及Campos肺萎陷分级评定肺萎陷程度。在入室时,双肺通气时,T1、T2、T3时测血气记录PaO2;记录术后第3天胸部CT检查肺不张的发生率、术后住院时间及肺部浸润影的发生率。 结果 T0时两组肺萎陷评分及Campos评级差异无统计学意义(P>0.05),T1和T2时B组肺萎陷评分及评级高于A组(P<0.05),T3时两组差异无统计学意义(P>0.05)。B组的氧分压在双肺通气及T1时高于A组(P<0.05),T2、T3时两组PaO2差异无统计学意义(P>0.05)。术后肺不张发生率、术后住院时间及术后肺部浸润影发生率两组之间差异无统计学意义(P>0.05)。 结论 OLV之前吸入100%氧气能够使OLV时肺萎陷效果更好,而且对术后恢复情况无影响

关键词: 胸腔镜;肺萎陷;吸入氧浓度;单肺通气
Abstract:

Objective To investigate the effect of different inhalation oxygen concentration on the lung collapse and postoperative recovery of thoracoscopic surgery. Methods Patients who underwent elective thoracoscopic radical resection of lung cancer were randomly divided into group A (n=29) and group B (n=30). Patents in the group A received a gas mixture of oxygen and air (FiO2=50%) whereas and patients in the group B received 100% oxygen(FiO2=100%) until the start of one lung ventilation (OLV). Then, the dependent lungs were ventilated with 50% oxygen during OLV in both groups. The surgeon evaluated the lung collapse using LCS score and Campos score for lung collapse. They were scaled at 1 min after the opening of the pleura(T0), 10 min after the start of OLV (T1), 20 min after the start of OLV (T2) and 30 min after the start of OLV (T3). During two lungs ventilation, arterial blood gases were measured before anesthesia induction, at 10, 20, 30 min after initiation of OLV. The incidence of postoperative atelectasis by chest CT at the third day after operation, hospital length of stay(LOS) and the incidence of patchy consolidation were recorded. Results At T1 and T2, the LCS scores and Campos scales of group B were higher than scores of group A (P<0.05), but the difference between the two groups was not obvious at T0 and T3(P>0.05). The oxygen partial pressure of group B was higher than that of the group A before 20 min of OLV, but the difference were not significant after 20 min. The incidence of postoperative atelectasis, LOS and the incidence of patchy consolidation were not different (P>0.05) Conclusions The inhalation of 100% oxygen before the OLV can make the pulmonary collapse effect better, and it has no effect on postoperative recovery.

Key words: Video assisted thoracic operation; Pulmonary collapse; Fraction of inspired oxygen; One lung ventilation