双侧肺同期手术中不同体位和单肺通气对病人呼吸力学的影响

Effects of different positions and one-lung ventilation modes on respiratory mechanics of patients during bilateral pulmonary surgery

目的观察双侧肺同期手术中体位改变和单肺通气时对病人呼吸力学的影响。方法选取我院2007年6月至2010年12月双侧肺同期手术病人142例,经气道旁路采用旁气流通气连续监测病人PIP、Pplat、Raw、Cdyn等呼吸力学指标,监测SpO2、PETCO2指标,分别在双腔支气管导管定位后,平卧改侧卧,单肺通气及改换通气方式后10 min抽取动脉血进行血气分析。结果病人双肺通气改变体位和单肺通气后,病人PIP、Pplat、Raw升高,Cdyn减少,PH值降低,PETCO2、PaCO2升高、SpO2、PaO2降低(P<0.05);双肺通气改换通气方式后,病人PIP、Pplat、Raw降低,Cdyn增加,PH值降低,PaO2、SpO2、PaCO2、PETCO2升高(P<0.05)。单肺通气38例病人改换通气方式后,病人PIP、Pplat、Raw降低,Cdyn增加,PH值、PaO2、SpO2升高,PaCO2、PETCO2降低(P<0.05)。结论双侧肺同期手术麻醉中不同体位和单肺通气对病人的呼吸力学影响较大,改换通气方式可改变病人呼吸力学指标。

Objective To investigate the effects of different positions and one-lung ventilation modes on respiratory mechanics of patients during bilateral pulmonary surgery.Methods Analysis on 142 cases who underwent bilateral pulmonary surgery from June,2007 to December,2010.PIP,Pplat,Raw and Cdyn measures were continuous monitored by side stream spirometry while SpO2 and PETCO2 were observed on the Patient Monitor.After dual cavity bronchus vessel was fixed and different ventilation modes were applied,blood gas analyses were made after 10 min with patients in lateral positions.Results When patient was changed to a lateral position under double-lung ventilation and when one-lung ventilation mode was applied,PIP、Pplat、Raw increased while Cdyn decreased,and PH decreased while PETCO2 and PaCO2 increased with SpO2 and PaO2 decreasing（P0.05）.When a different ventilation mode was applied under double-lung ventilation,PIP,Pplat and Raw decreased while Cdyn increased,PH decreased while PaO2、SpO2、PaCO2、PETCO2 increased（P0.05）;when 38 cases were applied with a different ventilation mode under one-lung ventilation,PIP,Pplat and Raw decreased significantly while Cdyn increased,PH,PaO2 and SpO2 increased while PaCO2 and PETCO2 decreased（P0.05）.Conclusion Different positions and ventilation modes have great effect on respiratory mechanics of patients during bilateral pulmonary surgery,and appropriate ventilation modes can improve respiratory mechanics and prevent hypoxemia,hypercarbia and barotraumas to protect lungs.