高频喷射通气辅助单肺通气在Ⅰ型呼吸衰竭患者胸科手术中的应用

Application of HFJV Assisted OLV in Patients with Type 1 Respiratory Failure Undergoing Tho- racic Surgery

【目的】探讨单肺通气（OLV）中非通气侧肺高频喷射通气（HFJV）在I型呼吸衰竭患者中的作用。【方法】选择合并I型呼吸衰竭全麻单肺通气胸科手术患者34例，随机分为两组，每组17例，全麻快速诱导后插入双腔支气管导管，HFJV组（H组）单肺通气后非通气侧肺行HFJV；对照组（C组）行单肺通气。分别于麻醉前（T0）及0LV前（T1）、OLV后10min（T2）、30min（T3）、60min（T4）、术毕恢复双肺通气后10min（T5）行血气分析，计算肺内分流率[肺内分流量／心输出量（Qs／Qt）]，同时监测气道压力并计算肺顺应性（Cdyn）。【结果】C组有4例患者由于严重低氧血症退出该研究；与T，时比较，Tz～Ta时两组PaO2均下降，Qs／Qt、气道峰压（Pmax）升高、Cdvn下降（P〈0．05）；与C组比较，H组Tz～Tt时Paoz显著增高、Qs／Qt显著降低，其差异均有统计学意义（P〈0．05），Pmax、Cm无显著性差异（P〉0．05）。【结论】高频喷射通气辅助单肺通气可降低I型呼吸衰竭患者肺内分流，维持较好的PaO2。

[Objective][Objective]To explore the role of high-frequency jet ventilation（HFJV） of non-ventilation lung during one-lung ventilation（OLV） in patients with type I respiratory failure. [Methods] Thirty four patients with type I respiratory failure undergoing OLV were randomly divided into two groups with 17 cases in each group. After induction of anesthesia, a double-lumen endotracheal tube was introduced. HFJV group（group H） underwent HFJV of non-ventilation lung after OLV. Control group（group C） underwent OLV. Blood gas analysis was taken be- fore anesthesia（T0）, before OLV（T1 ）, at 10min（T2 ）, 30min（T3 ） and 60rain after OLV（T4 ） and 10rain after two lung ventilation（T5 ）. Intrapulmonary shunt volume/cardiac output （Qs/Qt） was calculated. Airway pressure and lung compliance（Cap,） were monitored. [Results]Four patients in group C quitted the research because of severe hy- poxemia. Compared with T1, PaO2 and Cdyn at T2 -T4 decreased（ P 〈0.05）, while Qs/Qt and maximum airway pressure（Pin.x） increased（ P 〈0.05）. Compared with group C, PaO2 in group H at T2 -T4 markedly increased, while Qs/Qt markedly decreased, and there was significant difference（ P 〈0.05）. There was no significant differenee in Cayn and Pmax （ P 〉0.05）. [Conclusion] HFJV assisted OLV can decrease Qs/Qt and maintain a better PaO2 in patients with type I respiratory failure.