单肺通气期间连续气道正压通气对胸腔镜房间隔缺损修补术患者肺功能的影响

Effect of continuous positive airway pressure during one lung ventilation on pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect

目的 探讨单肺通气期间连续气道正压通气（CPAP）对胸腔镜房间隔缺损修补术患者肺功能的影响。方法拟行房间隔缺损修补术的患者20例，年龄16—30岁，体重41～64蛀，性别不限，ASA分级Ⅱ级，随机分为2组（n=10）：对照组和CPAP组。两组单肺通气时VT8ml／kg，呼吸频率12．16次／min，吸呼比1：2，维持PETCO235～40mmHg。CPAP组单肺通气期间，非通气侧肺采用CPAP，压力为6cmH2O2术中监测氧合指数、肺顺应性和气道压，记录拔管时间、单肺通气期间心血管事件和低氧血症的发生情况。结果与对照组比较，CPAP组氧合指数和肺顺应性升高，拔管时间缩短，低氧血症发生率低（P〈0．01），两组患者气道压力在正常范围且未发生心血管事件。结论单肺通气期间行CPAP（6cmH2O）可改善胸腔镜房间隔缺损修补术患者的肺功能。

Objective To investigate the effect of continuous positive airway pressure （CPAP） during one lung ventilation on pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect. Methods Twenty ASA Ⅱ patients of both sexes, aged 16-30 yr, weighing 41-64 kg, scheduled for video-assisted thoracoscopic repair of atrial septal defect, were randomly divided into 2 groups （ n = 10 each） ： control group and CPAP group. One lung ventilation （VT 8 ml/kg, RR 12-16 bpm, I：E 1：2, PFrCO： 35-40 mm Hg） was perform in both groups. CPAP （ 6 cm H20 ） was perform during one lung ventilation in group CPAP. The oxygenation index, pulmonary compliance and airway pressure were recorded during operation. The cardiovascular events, hyoxemia and extubation time were recorded. Results The oxygenation index and pulmonary compliance were significantly higher, extubation time was shorter, and the incidence of hyoxemia was lower in CPAP group than in control group （ P 〈 0.01 ）. The airway pressure was in the normal range in both groups. No cardiovascular events was found in both groups. Conclusion CPAP （6 cm H2O） during one lung ventilation can improve the pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect.