剖胸术中控制肺膨胀度的低通气策略

Lower ventilation strategy for controlling lung expansion degree in thoracotomy

目的:为了给胸外科开胸手术提供开阔的术野,探讨了术中控制肺膨胀度采取低潮气量通气技术的临床可行性。方法:对90例肺切除病例依据肺膨胀度80%,50%和30%随机分为3组,在麻醉术中设计低潮气量通气模式,在手术进行0min,30min,60min,90min和120min各时段监测SaO2%和ETCO2,并记录数据。设置SaO2%和ETCO2安全界限并在范围内观察研究。结果:肺膨胀度80%组在手术0～120min内,SaO2%和ETCO2变化不明显(P>0.05);肺膨胀度50%组在术时90～120minSaO2%和ETCO2变化明显(P<0.05);肺膨胀度30%组在60～90min SaO2%和ETCO2已接近安全设限,手术时间限于90min。结论:剖胸术中以低通气量维持肺膨胀度80%手术时限可达120min,肺膨胀度50%达90～120min,肺膨胀度30%术时60～90min。剖胸术中全麻采用低潮气量通气可以控制肺膨胀度,有利于肺外科手术操作和手术安全,但需密切监测SaO2%和ETCO2的变化。

Objective To explore the degree of controlling lung expansion with low tidal volume ventilation technology and the clinical feasibility in an attempt to provide an wide operative field in thoracic operation.Methods：Based on the lung expansion of 80%,50% and 30%,90 cases of pulmonary resection were randomly divided into 3 groups,the low tidal volume ventilation modal was designed in anesthesia,at 0m,30m,60m,90m and 120m operation time,the SaO2% and ETCO2 were monitored,the data of SaO2% and ETCO2 were recorded and observed,and the safe limits were set up.Results：The SaO2% and ETCO2 of 80% lung expansion degree group had no significant change（P0.05） at 0m to 120m operation time,SaO2% and ETCO2 of 50% lung expansion degree had significant change at 90m to 120m（P0.05）,and at 60m to 90m,SaO2% and ETCO2 of 30% lung expansion degree were near to safety limit and the operation time was limited to 90m.Conclusion： The safe operation time of 80% lung expansion degree is 120m with low ventilation in thoracotomy,the 50% group was 90m to 120m and 30% was 60m to 90m.The degree of lung expansion can be controlled by low tidal volume ventilation in thoracotomy and general anesthesia for the safety and easiness of pulmonary surgical procedures,but the changes of SaO2% and ETCO2 need to be closely monitored.