呼气末正压对低潮气量单肺通气氧合及气道压力的影响

Effects of Positive End-Expiratory Pressure on Oxygenation and Airway Pressure During One-Lung Ventila-tion with Low Tidal Volume

目的观察30例开胸手术病人行低潮气量单肺通气期间呼气末正压(PEEP)对动脉氧分压、脉搏血氧饱和度及气道压力的影响。方法所有病人开胸后行容量控制低潮气量单肺通气,单肺通气20min后加4cmH2OPEEP,20min后再恢复0cmH2OPEEP状态。双肺通气20min后、单肺通气20min后、单肺通气加用4cmH2OPEEP20min后以及恢复单肺通气0cmH2OPEEP20min后分别采动脉血进行血气分析,同时记录血流动力学参数、脉搏血氧饱和度及气道压力,将组内单肺通气应用PEEP前后动脉血氧分压值、脉搏氧饱和度及气道压力进行比较。结果低潮气量单肺通气与常规潮气量单肺通气相比气道压力大大减小;4cmH2OPEEP对血流动力学无影响,且可显著改善动脉氧合、提升脉搏血氧饱和度。结论低潮气量容量控制单肺通气时加用4cmH2OPEEP可作为改善单肺通气动脉氧合的一种方法,对开胸手术也是一种保护性通气策略。

Objective To observe the effects of positive end-expiratory pressure （PEEP） on oxygenation during one-lung ventilation（OLV） with low tidal volume for thoracic surgery. Methods Thirday patients undergoing thoracic surgery were observed. OLV with low tidal volume without PEEP was applied when opening chest after two-lung ventilation, then 4 cmH20 PEEP was used and was cancelled after a period of time.Blood gas analysis were determined immediately before one-lung ventilation, 20 rain following OLV, 20 min following OLV with 4 cmH20 PEEP, and 20 min after resuming OLV without PEEP, meanwhile, the hemodynamic parameter, SpO2 and airway pressure were recorded. Results During OLV with low tidal volume and 4 cmH2O PEEP, SpO2 and PaO2 were increased sign/ficantly than that without PEEP （P 〈 0.05）, and the hemodynamics was not influnced by 4 cmH20 PEEP. Conclusion OLV with low tidal volume and 4 cmH20 PEEP may be applied to improve the arterial oxygenation during OLV and should be concidered as a protective ventilation strategy for thoracic surgery.