低流量单肺通气对肺癌手术患者呼吸功能的影响

Effects of low flow anesthesia on respiratory function during one lung ventilation in patients with lung cancer surgery

目的观察低流量单肺通气对肺癌手术患者呼吸功能的影响。方法 40例需单肺通气的择期肺癌手术患者,ASAⅠ～Ⅱ级,随机分为常流量组(A组)和低流量组(B组),各20例。两组单肺通气前吸入高流量(4 L/min)的氧气和1%安氟醚,10 min后将A组氧气流量调为3 L/min,B组调为1 L/min,两组每60 min给予高流量(4 L/min)的新鲜气体吸入5 min,手术结束前30 min停止吸入安氟醚,恢复吸入氧气流量至4 L/min。在单肺通气前(T0)及单肺通气后10 min(T1)、30 min(T2)、60 min(T3)及恢复双肺通气30 min(T4)时,记录气道峰压(Ppeak)、气道平均压(Pmean)、气道阻力(Raw)、动态肺顺应性(Cdyn),行动脉血气分析并记录动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)。结果两组患者单肺通气各时点较双肺通气时Ppeak、Pmean、Raw增加(P均<0.01),Cdyn、PaO2下降(P均<0.01);其他各指标两组间相近(P均>0.05)。结论低流量单肺通气对肺癌手术患者呼吸功能的影响较小,低流量麻醉可安全用于单肺通气。

Objective To investigate the effects of low flow anesthesia on respiratory function during one lung ventila- tion in patients with lung cancer surgery. Methods A total of 40 ASA I or II grade patients, scheduled for lung cancer surgery under one lung ventilation （OLV） were randomly divided into two groups with 20 each ： normal flow anesthesia group（ Group A） and low flow anesthesia group（ Group B）. Before OLV, two groups received high oxygen flow of 4 L/min and inhaled 1% enflurane for ten minutes, then the oxygen flow was decreased to 3 L/rain in group A and 1 L/min in group B, and two groups received high flow fresh gas of 4 L/min per 60 minutes for 5 minutes during OLV. The inhalation of en- flurane was stopped at 30 min before operation cease and then the oxygen flow was recovered to 4 L/min until operation cease. Peak airway pressure（Ppeak） , mean airway pressure（Pmean） , airway resistance（Raw） , lung compliance（Cdyn） , arterial oxygen pressure（ PaO2 ）, carbon dioxide pressure（ PaCO2 ） were recorded before OLV（ T0 ） and at 10 min（ T1 ）, 30 min（T2） , 60 min（T3） min after OLV, 30 rain （T4） after two lung ventilation. Results Ppeak, Pmean, Raw were in- creased （ all P 〈 0.01 ） and Cdyn, PaO2 were decreased from T1 to T3 when compared with To in two groups （ all P 〈 0. 01 ）, there was no significant difference in other parameters from TO to T4 between the two groups. Conclusion Low flow anesthesia has little effect on respiratory function in patients with lung cancer surgery. Low flow anesthesia can be safely used for one-lung ventilation.