单肺通气期潮气量对肺内分流及动脉氧合的影响

Effects of tidal volume on arterial oxygenation and intrapulmonary shunt during one lung ventilation

目的研究单肺通气(OLV)时不同潮气量(VT)对肺内分流及动脉氧合的影响。方法 60例右肺部分切除术患者随机均分为A、B、C三组。全麻后双肺通气(TLV)时VT均为10ml/kg,RR均为12次/分,吸呼比(I∶E)均为1∶2。OLV期间,A组VT6ml/kg,RR20次/分;B组VT8ml/kg,RR15次/分;C组VT10ml/kg,RR12次/分;分别于OLV前(T1)及OLV后10min(T2)、20min(T3)、30min(T4)行血气分析,计算肺内分流(QS/QT),同时监测气道压力并计算肺顺应性(Cdyn)。结果与T1时比较,T2～T4时三组均有PaO2下降,QS/QT、气道峰压(Pmax)增高,Cdyn下降(P<0.05)。与A组比较,B组PaO2升高(P<0.05)。结论 OLV期间采用VT8ml/kg,RR15次/分能够维持相对较好的PaO2和Cdyn,较小的QS/QT。

Objective To investigate the effects of different tidal volume（VT） on arterial oxygenation and intrapulmonary shunt（QS/QT） during one lung ventilation（OLV）.Methods Sixty patients scheduled for selective lobectomy under left lateral decubitus position were randomly divided into groups of A,B and C with 20 cases each.After bronchial induction,two lung ventilation（TLV） was performed with VT 10 ml/kg,frequency（f）12 breaths per minute（BPM）,ratio of inspiration to expiration（I：E） was 1：2 at first.During OLV,I：E was kept steady,VT 6 ml/kg and f 20 BPM were chosed in group A,VT8 ml/kg and f 15 BPM in group B,VT 10ml/kg,f 12 BPM in group C.Blood gas analysis was determined before OLV （T1） and at 10 min（T2）,20 min（T3）,and 30 min after OLV（T4）.QS/QT and lung complience（Cdyn） was calculated.Results OLV Compaired to T1,PaO2 and Cdyn were lower（P〈0.05） and QS/QT and peak airway pression were increased（P〈0.05）.The decrease of PaO2 was more in groups of A and C than that in group B（P〈0.05）.Conclusion During OLV,a better PaO2 may be maintained with the ventilation parameters of VT 8 ml/kg and f 15 BPM with less increase in QS/QT and higher Cdyn.