直接气道压力监测在肺部手术的应用

Clinical observation of direct measurement of airway pressure in pulmonary surgery

目的探讨光纤压力传感器(FOPT)直接气道压力监测在肺部手术中的应用及其临床意义。方法30例行肺部手术的患者,根据术前肺功能情况分为肺功能正常组(14例)和肺功能异常组(16例),麻醉诱导气管插管后,将FOPT插入双腔气管导管的左右腔,所测压力分别为支气管压力和主气道压力,持续监测气道压力至术后30 min。观察围术期气道压力的变化。结果单肺通气过程中,两组患者的主气道压力都随着单肺通气时间的延长而增加;肺功能正常组在单肺通气过程中各时间点的主气道压力的差异均无统计学意义(P值均>0.05),肺功能异常组在单肺通气90 min及结束时的主气道压力较单肺通气开始10 min时显著增加(P值均<0.05)。双肺通气过程中,肺功能正常组术毕和术后30 min支气管压力和主气道压力与麻醉诱导后的差异均无统计学意义(P值均>0.05);肺功能异常组在术毕和术后30 min的支气管压力和主气道压力均较麻醉诱导后显著增加(P值均<0.05)。结论在肺部手术应用FOPT直接测压可及时反映气道的实际压力,有助于气道管理。术前肺功能异常患者术中易出现气道压力升高,且术后不易下降,这可能与肺损伤有关。

Objective To observe the airway pressure measured directly by the fiber optic pressure transducer in pulmonary surgery.Methods Thirty patients scheduled for elective pulmonary surgery were divided into two groups according to the pulmonary functions before operation： the normal pulmonary function group（n=14） and the abnormal pulmonary function group（n=16）.After the double lumen tube insertion,the fiber optic pressure transducer was inserted into the left and right lumen： Pbronchi and Pairway.The airway pressure was measured continuously till 30 min postoperatively by the fiber optic pressure transducer.Results During one-lung ventilation,Pairway was increased with time in both groups.But Pairway had no significant change in the normal pulmonary function group,and was significantly increased at 90 min after the beginning of one-lung ventilation and at the end of one-lung ventilation in the abnormal pulmonary function group.During two-lung ventilation,there was no significant increase in Pbronchi and Pairway of the normal pulmonary function group,and those of the abnormal pulmonary function group were increased significantly at the end of the operation and 30 min after the operation.Conclusion The fiber optic pressure transducer can provide a direct airway pressure measurement,which is useful in airway management.In the pulmonary surgery,the airway pressure has more changes in patients with abnormal pulmonary function than in those with normal pulmonary function,which may be related to lung injury.（Shanghai Med J,2010,33： 140-142）