单肺通气期间非通气侧肺持续给氧对氧合及肺内分流的影响

Influence of Continuous Oxygen Supply on Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventition

目的探讨单肺通气(OLV)期间非通气侧肺持续吹入氧对减少肺内分流和预防低氧血症的作用。方法择期开胸手术患者22例,ASAⅠ-Ⅱ级,随机分为对照组(A组)、观察组(B组)2组,每组各11例。B组在OLV期间非通气侧肺持续吹入氧气(1～3 L/min),A组在OLV期间非通气侧肺的支气管导管直接开口于大气中;并于OLV前(T1)、OLV30 min(T2)、OLV60 min(T3)、关胸双肺通气(TLV)30 min,分别采动脉血作血气分析并计算肺内分流率(Qs/Qt值)。结果在OLV30 min及OLV60 min时,B组动脉血氧分压显著高于A组(P<0.05);OLV30 min时B组Qs/Qt显著低于A组(P<0.05)。结论OLV期间非通气侧肺持续吹入氧气可以明显提高动脉血氧分压,减少肺内分流,减小低氧血症的发生率。

Objective To investigate the effects of non-ventilated lung with continuous oxygen supply on arterial oxygenation and intrapulmonary shunt during one-lung ventilation （OLV）. Methods Twenty-two patients were randomized to receive thoracic operation. ASA Ⅰ -- Ⅱ ,were selected and were randomly divided into two groups： controlled group（group A,n= 11）and observation group（group B,n= 11）. In group A, there was no ventilation on the non-ventilated lung open to the air. In group B,oxygen supply was administered with 1-3 L/min on the non-ventilated lung during OLV. Blood gas analysis was determined at 30 min after two-lung ventilation （TLV）in the supine position,30 min after OLV in supine position, 30 and 60 min after OLV in lateral position and at the end of operation. Results 30 and 60 min after OLV,PaO2 in group B/ was increased significantly than that in group A （P〈0. 05） during OLV. 30 min after OLV, Qs/ Qt in group B decreased significantly than that in group A （P〈0.05）. Conclusion Continuous oxygen supply could improve the systemic oxygenation and reduce the intrapulmonary shunt and incidence rate of hypoxemia during one lung ventilation.