阻塞性通气障碍患者机械通气时呼吸系统黏性阻力变化的研究

Changes of Viscous Resistance of Respiratory System in Patients with Obstructive Lung Disease under Mechanical Ventilation

目的:应用脉冲振荡肺阻力测定法(IOS)探讨间歇正压控制性机械通气(IPPV)时呼吸系统黏性阻力变化规律。方法:择期左肺肿瘤切除成年男性患者25例,根据术前肺功能测定指标分为非阻塞性肺病组(NOLD组)15例和阻塞性肺病组(OLD组)10例,所有受试者麻醉后于仰卧位和右侧卧位行双肺及右肺通气测试,应用IOS方法测定Carlen双腔气管导管5Hz(R5)、10Hz(R10)和15Hz(R15)黏性阻力。结果:相同振荡频率双肺通气OLD组黏性阻力显著增加,与NOLD组比较,差异有统计学意义(P<0.05)。不同潮气量和呼吸频率侧卧位单肺机械通气时NOLD组患者黏性阻力变化差异无统计学意义。当潮气量≤8mL·kg-1、呼吸频率≥12次·min-1单肺通气时,组间R5差异有统计学意义(均P<0.05)。结论:术前肺通气功能正常或仅轻度损伤的患者,围术期用Carlen双腔管做侧卧位非手术侧单肺通气,潮气量4～10mL·kg-1,呼吸频率10～18次·min-1,不改变其呼吸动力学特性。

Objective：To study the changes of viscous resistance of respiratory system under intermittent positive pressure ventilation（IPPV） by means of impulse oscillometry（IOS）.Methods：Twenty-five male patients scheduled for left pneumolobectomy were divided into 2 groups,non-obstructive lung disease（NOLD,n = 15） and obstructive lung disease（OLD,n = 10） according to their perioperational pulmonary function test results.All the patients breathed with double-lung and right lung mechanical ventilation at dorsal and right lateral positions after anesthetization.The values of viscous resistance were taken in the respiratory system at 5 Hz,10 Hz and 15 Hz oscillation frequencies（R5,R10 and R15）.Results：The viscous resistance of Carlen double-lumen tube was measured at 5,10 and 15 Hz by IOS method.The resistance was the lowest at 5 Hz.Under double lung mechanical ventilation the viscous resistance was significantly increased at R5,R10 and R15 in OLD group compared with that of NOLD group,P 〈0.05.Under single lung ventilation,the changes of R values were not significantly different in NOLD group at different tidal volume and respiratory frequencies when the patient was kept at lateral position.However,R5 differed significantly between the two groups when Vt≤8 mL·kg^-1,f ≥12 times·min^-1 under single lung ventilation.Conclusion：For the patients with normal or light damaged respiratory function,during the perioperational period under one side ventilation with Carlen double-lumen tube,while the tidal volume varied from 4-10 mL·kg^-1 and the respiratory frequency varied from 10-18 times/min,the pneumodynamical characteristics were not affected.