单肺通气时机械通气模式的研究进展

Research progress on one4ung mechanical ventilation modes

背景单肺通气（one lung ventilation，OLV）实施过程中最常见的并发症是低氧血症，也是麻醉医师遇到的最严重的挑战。目的近来研究表明OLV本身能够引起低氧血症和急性肺损伤（acute lung injury，ALI）。因此，如何实施OLV时机械通气模式，降低肺内分流率（pulmonary shunt fraction，Qs／Qt）、预防低氧血症一直是临床研究的热点。内容综述提高吸入氧分数（fraction of inspiration O2，FiO2）、控制通气模式、高频通气（high frequency ventilation，HFV）、潮气量（tidal volume，Vt）、反比通气、部分液体通气（partial liquid ventilation，PLv）、持续气道正压通气（continuous positive airway pressure，CPAP）、呼气末正压通气（positive end-expiratory pressure，PEEP）等通气模式，以及实施联合多种模式的保护性肺通气策略。趋向综合运用多种预防OLV期间低氧血症的通气模式取得良好的效果，但应针对患者和手术情况制定OLV时机械通气模式。

Background Hypoxemia is one of the most common complications and the most important challenge during one lung ventilation（ OLV ）. Objective Recent studies have shown that OLV can cause severe hypoxemia and acute lung injury （ALI）. How to implement OLV strategy to reduce pulmonary shunt fraction （Qs/Qt） and prevent hypoxemia has always been a research hot spot. Content The strategy used to improve oxygenation involve increased inspired oxygen fraction （FiO2）, control ventilation modes, high frequency ventilation （HFV）, tidal volume （Vt）, inverse ratio ventilation, partial liquid ventilation （PLV）, continuous positive airway pressure （CPAP）, positive end-expiratory pressure （PEEP） and combined multiple protective ventilation strategies. Trend The combined ventilation strategy can prevent hypoxemia during OLV. But mechanical ventilation modes should be set on the basis of patient＇s condition and operation.