超前肺复张策略提高开胸单肺通气期间的氧合

A preemptive alveolar recruitment strategy improves arterial oxygenation during one lung ventilation

目的探究超前肺复张策略提高开胸单肺通气期间的氧合。方法 40例择期肺叶切除左支气管插管患者,随机分成两组,超前肺复张(PARS)组单肺通气(OLV)前先给累计10次使气道峰压缓慢达到40 cm H2O的手工通气,对照组(C组)不采用PARS策略。记录OLV后15、30、45、60 min及OLV结束前的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、动脉氧分压(PaO2),计算肺胸的动态与静态顺应性。结果 PARS组较C组PaO2均有增加,尤以OLV 15 min及OLV结束差异显著(P<0.01),另外A-aDO2减少,尤以OLV 15 min及OLV结束时有显著差异(P<0.01)。结论OLV前PARS加PEEP策略提高单肺通气期间的氧合。

Objective To evaluate the effect whether a preemptive of alveolar recruitment strategy （PARS） before one-lung ventilation（OLV） improves arterial oxygenation during OLV in patients undergoing thoracic surgey. Methods Forty patients undergoing elective thoracic surgery. After inducion of anaesthesia, a left-side Mallinckrodt double-lumen tube was in- serted, and its final position was comfirmed using a fibreoptic bronchoscope in the lateral position. After double lung venti- lation five minutes, arterial blood sample was obtained through the radial catheter as base data.Then the patients were ran- domLy divided into PARS and C groups. PARS group （n = 20） consisted two thechniques：First 10 manul breaths with a peak inspiratory pressure of 40 cm H：O were performed and subsequently PEEP 5 em H20 was applied to both lungs in volume control mode.Those in group C（n = 20）received no ARS,but applied 5 cm H2O PEEP afer the lateral position. During OLV, recorded ： mean arterial pressure （MAP）, central venous pressure （CVP）, heart rate （HR）, alveolar-arterial oxy- gen tension （PaO2）and dynamic and static compliances difference after 15,30,45,60 min of OLV, and at the end of OLV. Results PaO2 was signficantly higer in group PARS than in group C after 15 rain of OLV and the end of OLV （P 〈 0.01 ）. The alverolar-arterial oxygen tension difference （A-aDO2）was significantly lower in group PARS than in group C afer 15 min of OLV and at the end of OLV（P 〈 0.01 ）. Conclusion A preemptive alveolar recruitment strategy before one-lung ventila- tion improves arterial oxygenation during one lung ventilation