静脉输注高氧液对单肺通气期间低氧血症的治疗作用

The Therapeutic Effects of Intravenous Hyper-Oxygenated Solution Infusion on Hypoxemia During one-Lung Ventilation

目的：探讨静脉输注高氧液对家猪OLV时肺内分流与氧合的影响。方法：30头健康家猪（25-35kg）建立OLV模型后，随机分为2组，每组15头，即高氧液组（H组）和对照组（c组），H组动物在单肺通气后经右静内静脉以15mL·kg-1·h4的速度恒速输入高氧液，c组动物则以相同的方式和速度输入等量的乳酸林格氏液。分别于双肺通气时、单肺通气30min、单肺通气60min时抽取动脉血和混合静脉血做血气分析，并计算肺内分流率（Qs／Qt％），同时记录血流动力学指标。结果：与双肺通气时相比，单肺通气时两组Pa02，Sa02,PvO2和Sv02均显着降低，雨Qs／Qt％明显升高（P〈0．01）。羊肺通气30min以及60mm后，H组的Pa02，SaO2，PvO2和SvO2等指标均显薯高于C组（p〈0．05），而对于肺内分流率（Qs／Qt％），两组间比较差异无统计学意义。结论：静脉榆注高氧液虽然对肺内分流影响不大，却能够明显改善氧合，治疗单肺通气引起的低氧血症。

Objective： To investigate whether intravenous hyper-oxygenated solution （HOS） infusion would improve systemic oxygenation and reduce intrapulmonary shunt during OLV. Methods： Thirty pigs （25-35 kg） were anesthetized, tracheally intubated, and mechanically ventilated. ARer placement of femoral arterial and pulmonary artery catheters, a lett-sided double-lumen tube （DLT） was placed via tracheotomy. The animals were allocated randomly to one of the two study groups （n=15 each）; control group （C group）and hyper-oxygenated solution group （H group）. Animals in H group received intravenous HOS infusion immediately after the beginning of OLV via internal right jugular vein with an infusion pump, and the rate of infusion was 15ml-kg-l-hl; and in C group, the same amount of lactate Ringer＇s solution （LRS）was used in place of HOS. Arterial and venous blood gases analysis were recorded in three phases： during two-lung ventilation （TLV）, 30 min alter beginning OLV （OLV＋30）, and 60 rain after beginning OLV （OLV＋60）. We measured arterial oxygen saturation （SaO2）, mixing venous oxygen saturation （svo2）, partial pressure of arterial oxygen （PaO2）, partial pressure of mixing venous oxygen （l＇vOg, and venous admixture percentage （Qs/Qt~/0）. Heart rate （HR）, mean arterial pressure （MAP）, mean pulmonary artery pressure （MPAP）, and cardiac output （CO） were also recorded. Results： Initiation oFOLV caused a significant decrease in PaO2, SaO2, PvO2 and SvO2, and a significant increase in Qs/Qt % during conversion from TLV to OLV in both groups （P〈0.01）. After 30 and 60 min OLV, the PaO2, SaO2, PvO2, and SvO2 values in H group were significantly higher than those in C group （P〈0.05）. When comparing the values of Qs/Qt % between the two groups in OLV＋30 and OLV＋60, there were no significant differences. Conclusions： Intravenous HOS infusion led to minimal changes in intrapulmonary shunt, nevertheless, could ameliorate arterial oxygenation obviously during OLV. This might be a new protective strategy against hypoxemia induced by OLV.