低潮气量联合低呼气末正压通气用于老年患者单肺通气的临床研究

Clinical observation of low tidal volume with low positive end-expiratory pressure in one-lung ventilation patients undergoing thoracic surgery

目的探讨低潮气量(VT)联合低呼气末正压通气(PEEP)对老年患者实施胸科手术单肺通气的临床有效性。方法选择实施胸科手术的老年患者60例。随机均分为研究组和对照组。研究组患者术中采用低VT联合低PEEP;对照组术中采用常规通气方案。记录两组术中PaO2、PaCO2、PETCO2、MAP、CVP及气道峰压(Ppeak)。结果与对照组比较,单肺通气60min时研究组PaO2显著升高,Ppeak明显下降(P<0.05);两组不同时点PaCO2、PETCO2及MAP差异无统计学意义;研究组患者术后3d内有3例术后并发症,明显低于对照组的6例(P<0.05)。结论对于老年患者实施胸科手术采用低VT联合低PEEP通气可有效改善患者术后低氧血症,减少术后肺部并发症,有利于患者术后呼吸功能的恢复,可以安全有效地应用于老年开胸手术。

Objective To investigate the influence of using small tidal volume （VT） combined with low level of positive end expiratory pressure（PEEP） on respiratory function of aged patients undergoing thoracic surgery under general anesthesia. Methods Sixty aged patients scheduled for thoracic surgery were randomly divided into study group and control group. Intermittent positive pressure ventilation（IPPV） plus 3-5 cm HzO PEEP with VT of 4-6 ml/kg and RR of 15-18 bpm were applied to the patients in study group, while the condition for patients in control group was IPPV, VT 8-10 ml/kg, RR 12 bprn. The PaO2, PaCO2, PET CO2, MAP and central venous pressure（CVP） of both groups were continuously monitored during operation for comparison. Results At 60 mins after the start of one-lung ventilation,PaO2 of study group was significantly higher than that of control group （P〈0.05）, while PaO2 ,PaCO2, PETCO2, MAP and CVP were not significantly different between the two groups at the studied time points. There were 3 case of postoperative complications in study group,significantly lower than those of control group of 6 cases at 3 d after surgery （P（0.05）. Conclusion Small tidal volume combined with low level of PEEP in thoracic surgery can reduce the risks of postoperative hypoxemia and other complications in old patients, which benefits the recovery of respiratory function without affecting hemodynamics. It is a safe and effective way of ventilation for aged patients receiving thoracic surgery under general anesthesia.