摘要
目的探讨反比通气对单肺通气老年患者肺功能和脑氧饱和度的影响。方法选取择期拟行食管癌根治术的老年患者60例,随机分为试验组(A组)和对照组(B组),每组30例,两组双肺通气期间VT7 mL/kg,I∶E=1∶2。单肺通气期间调整A组I∶E为1.5∶1,B组不变,于双肺通气15 min(T_1)、单肺通气20 min(T_2)、单肺通气60 min(T_3)、恢复双肺通气15 min(T_4)进行血气分析,记录血流动力学、呼吸力学指标和脑组织氧饱和度(rSO_2)。结果与B组比较,A组T_2~T_4时PaO_2、Pmean和Cdyn升高,Ppeak、VD/VT降低(P<0.05);单肺通气期间,A组rSO_2<50%或rSO_2降低>20%的发生率低于B组(P<0.05);与T_1时比较,两组在T_2~T_4时点PaO_2、Cdyn、rSO_2降低(P<0.05),Ppeak、Pmean、PaCO_2、VD/VT升高(P<0.05)。结论老年患者单肺通气期间采用反比通气可以降低术中气道峰压,改善氧合,增加肺顺应性,减轻rSO_2的下降程度。
Objective To investigate the effects of inverse ratio ventilation on pulmonary function and cerebral oxygen saturation in elderly patients with single lung ventilation. Methods Sixty patients scheduled for elective radical resection of esophageal cancer were divided into 2 groups （ n = 30 for each group ） using a random num- ber table ： the experiment group （group A） and the control group （group B）. During the two lung ventilation, the ventilator parameters were set as tidal volume （VT） 7 mL/kg, inspiratory to expiratory ratio 1 ： 2. During one lung ventilation, the I ： E ratio was 1.5 ： 1 in the group A and 1 ： 2 in the group B. At 15 rain after two lung ventilation （T,）, 20 rain after one lung ventilation （T2）, 60 min after one lung ventilation （T3） and 15 min after restarting two -lung ventilation （T4） , the blood gas analysis was measured and recorded for the hemodynamics, respiratory me- chanics index and cerebral oxygen saturation respectively. Results Compared with the B group, the Ppeak and VD/VT at T2- T4 in the group A were lower while PaO2, Pmean and Cdyn were higher （P 〈 0.05 ）. During one lung ventilation, the incidence of rSO2 〈 50% or rSO2 decreased more than 20% in the group A was lower than that in the group B （P 〈 0.05 ）. The PaO2, Cdyn and rSO2 of the two groups at T2 - T4 were significantly lower and Ppeak, Pmean, PaCO2, VD/VT were significantly higher than the baseline （T1） （P 〈 0.05）. Conclusion During onelung ventilation, prolonged inspiratory time can improve pulmonary function and lung compliance without increas- ing peak airway pressure, reduce the decline of rSO2 at the same time.
作者
李亚鹏
闫龙剑
陈捷
刘功俭
LI Yapeng , YAN Longjian , CHEN Jie , LIU Gongjian.(Xuzhou Medical University, Xuzhou 221002, Chin)
出处
《实用医学杂志》
CAS
北大核心
2018年第5期814-816,819,共4页
The Journal of Practical Medicine
关键词
反比通气
单肺通气
老年患者
肺功能
脑氧饱和度
inverse ratio ventilation
one-lung ventilation
elderly patients
pulmonary funetion
cerebral oxygen saturation
