保护性单肺通气在老年食管癌麻醉中的应用

Application of Protection of One-lung Ventilation in Elderly Esophageal Carcinoma Anesthesia

目的 观察老年食管癌手术时采用保护性单肺通气模式,对呼吸力学、血流动力学、肺呼吸生理学的影响,探讨保护性单肺通气最佳呼吸参数.方法 选择食管癌手术患者30例,ASAⅡ～Ⅲ级,随机分为A组（15例）和B组（15例）,快速静脉麻醉诱导下行双腔气管导管插管,先行双肺通气模式,潮气量为8～10 ml/kg,呼吸频率为10～12次/min,进胸后改行单肺通气.A组采用普通单肺通气模式（潮气量10 ml/kg,PEEP 0 cm H2O）,B组采用保护性单肺通气模式（潮气量6 ml/kg,将PEEP维持在8 cm H2O左右）.连续监测潮气量、气道峰压（Ppeak）、平均压气道（Pmean）、气道阻力（Raw）,动脉氧分压（PaO2）,监测心电图（ECG）、动脉血压（BP）、血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）,以及术后恢复情况.结果 B组术中潮气量、气道峰压（Ppeak）,呼气末二氧化碳分压（PETCO2）与A组比较,差异有统计学意义（P〈0.05）,B组住院时间短于A组,并发症发生率小于A组,2组比较差异均有统计学意义（P〈0.05）.结论 老年食管癌手术采用低潮气量结合呼气末正压的保护性肺通气可改善单肺通气中的氧合,有利于降低低氧血症的发生率.

Objective We observed influence of breathing mechanics,blood stream dynamics,lung breath physi- ology of single - lung protective ventilation in elderly esophageal cancer to discuss best breath parameter of single lung ventilation. Methods 30 cases of esophagus cancer surgery patients of ASA Ⅱ-Ⅲ, were randomly divided into A group and B group with 15 cases in each group. Double - lumen endotracheal tube intubation was inducted with rapid intravenous anesthesia, Double lung ventilation mode was used flint,with tidal volume 8 - 10 ml/kg and Respiratory frequency 10 - 12 times/min and one - lung ventilation was used after entering the pleural. Group A used normal modes of one - lung ventilation, （ tidal volume was 10 ml/kg, PEEP 0 cm H2 O）, and group B used protective modes of one - lung ventilation, （tidal volume was 6 mL/kg, PEEP maintained at 8 H： Ocm）, Continuous monitoring of tidal vol- ume, peak airway pressure （ Ppeak）, mean airway pressure （ Pmean）, airway resistance （ Raw）, arterial partial pressure of oxygen（ PaO2 ） , the electrocardiogram（ECG） , arterial blood pressure（BP） , oxygen saturation（ SpO2 ）and end- tid- al carbon dioxide tension（ PETCO2 ） and postoperative recovery were observed. Results Compared with group A, tidal volume, peak airway pressure （ Ppeak）, end - tidal partial pressure of carbon dioxide （ PETCO2 ） of group B was statisti- cally different （P 〈 0.05 ）. Group B had shorter hospitalization time than group A, and the complication rate was less than A group（P 〈 0.05）. Conclusion In operation of elderly patients with esophageal cancer,low tidal volume com- bined with positive end expiratory pressure lung protective ventilation improves oxygenation during one - lung ventila- tion, and can reduce the rate of hvooxemia.