摘要
目的研究反比通气对择期行食管癌根治术患者单肺通气时肺内分流及肺顺应性的影响。方法40例择期行食管癌根治术的患者随机分为两组:A组20例(吸呼比I∶E=1∶2)、B组19例(I∶E=1.5∶1)。分别于麻醉诱导后10min(T0),单肺通气后30min(T1)、60min(T2),恢复双肺通气后15min(T3)采取桡动脉血和混合静脉血做血气分析,记录呼吸力学指标(气道平台压、气道峰压、平均气道压)。结果单肺通气后T1、T2时,A组患者Qs/Qt、P plateau、Ppeak均高于B组,差异有统计学意义(P<0.01),PaO2/FiO2、Pmean、Cdyn、Cstat均低于B组,差异有统计学意义(P<0.01)。结论结果证明单肺通气时吸呼比为1.5∶1能有效的改善氧合,与传统机械通气模式相比,单肺通气时反比通气更有利于减少肺内分流并改善肺顺应性。
Objective To investigate the effect of inverse ratio ventilation on intrapulmonary shunt and pulmonary compliance in subjects undergoing one lung ventilation.Methods Forty patients undergoing elective esophageal surgery were randomly assigned to Group A conventional inspiratory-to-expiratory(I∶E)ratio(I∶E=1∶2)or Group B(I∶E=1.5∶1).Arterial blood gas analysis,mixed-venous blood gas analysis and respiratory mechanics measurements(plateau airway pressure,peak airway pressure,mean airway pressure)were performed 10 min(T0)after anesthesia induction,30 min(T1)and 60 min(T2)after initiation of one lung ventilation,and 15 min(T3)after restoration of conventional two lung ventilation.Results PaO2/FiO2 was significantly lower in Group A compared with Group B(P<0.01)after one lung ventilation.Qs/Qt after 30 and 60 min of one lung ventilation was higher in Group A compared with Group B(P<0.01).Pplateau,Ppeak was higher in Group A compared with Group B(P<0.01)and Pmean was higher in Group B than Group A(P<0.01)at T1 and T2.Pulmonary compliance was significantly lower in Group A compared with Group B(P<0.01)after one lung ventilation.Conclusion We conclude that,an I∶E ratio of 1.5∶1 resulted in a modest improvement in oxygenation,in terms of intrapulmonary shunt and pulmonary compliance,inverse ratio ventilation appeared to be superior to traditional model in patients undergoing one lung ventilation for elective esophageal surgery.
作者
李凤丽
王海云
LI Feng-li;WANG Hai-yun(Third Central Clinical College of Tianjin Medical University Department of Anesthesiology,Third Central Clinical College of Tianjin Medical University Tianjin Institude of Hepatobiliary disease Tianjin Key Laboratory of Artificial Cell Engineering Research Centre of The Ministry of Health,Tianjin 300170,China)
出处
《中国误诊学杂志》
CAS
2019年第6期256-259,共4页
Chinese Journal of Misdiagnostics
关键词
单肺通气
肺内分流
反比通气
肺顺应性
one lung ventilation
intrapulmonary shunt
inverse ratio ventilation
pulmonary compliance
