两种单肺通气模式对小儿肺叶切除时呼吸生理的影响

The effect of two modes of one-lung ventilation on lung lobectomy in pediatric patients

目的:观察定压和定容单肺通气模式对小儿单腔支气管插管下行肺叶切除术时呼吸生理的影响。方法:选择20例ASAⅠ-Ⅱ级肺部手术小儿,随机分为两组,每组10例。麻醉诱导后,行单侧支气管插管,侧卧位,Ⅰ组先采用单肺定容模式(OLV-VCV)通气,潮气量为8￣10ml/kg,25min后改为单肺定压通气(OLV-PCV),压力设定根据单肺定容的气道平台压而定。Ⅱ组先用单肺定压通气,压力设定以达到满意通气为准,25min后改为定容模式通气,潮气量根据单肺定压时的潮气量而定。用Datex-Ohmeda Anesttesia Delivery Unit(ADU)监测呼吸力学参数:气道锋压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)、分钟通气量(MV)、呼吸末二氧化碳分压(EtCO2)等。所有患儿均行有创动脉监测,并于麻醉前、通气后25min和50min取动脉血作血气分析(PaO2、PaCO2)。结果:两组患儿OLV-PCV与OLV-VCV比较,PaO2均升高(P<0.05),组间比较无显著性差异(P>0.05)。结论:小儿肺叶切除单肺通气期间采用定压通气较定容通气模式更有利于减轻单肺通气造成的血氧分压的下降。

Objective： To investigate the effect of two modes of one-lung ventilation （OLV） on lung lobectomy in pediatric patients. Metheds： Twenty ASA Ⅰ - Ⅱpatients （8 male, 12 female） aged 2-14 year, weighing 10-30 kg, and undergoing lung lobectomy were enrolled in this study. The patients were premedicated with intramuscular SOd Luminal 3-5 mg/kg and Atropine 0.01 mg/kg im, 30 minutes before induction. Induction was performed with Dorcum 0.1 mg/kg, Fentanyl 5 μ g/kg and Vecuronium 0.1 mg/kg, maintained with Vecuronium 70 μ g/（kg·h）and Propefol 5mg/（kg·h） iv boluses. Ordinary tracheal tube was inserted into bronchus （14right, 6 left） during OLV. First, OLV with volume-control mode maintained 25 min, and then, OLV with pressure-control mode was performed. In first step Vt was set at 8-10 ml/kg and respiratory rate was adjusted to maintain PetCO2 between 30-40 mmHg. In second step the inspiratory pressure was set according to the plateau pressure during step 1, hemodynamics and PaO2 were measured and recorded. Resets ： During OLV with pressure-control mode PaO2 was significantly increased, as compared with that during volume-control mode （P 〈 0.05）. Conclusion ： PaO2 is higher in OLV -PCV group than that in OLV -VCV group.