分肺机械通气治疗严重非对称性肺损伤的临床研究

Clinical study on the treatment of severe asymmetric lung injury through differential lung ventilation

目的探讨分肺机械通气（ DLV）治疗严重非对称性肺损伤的疗效。方法选择因严重非对称性肺损伤导致急性呼吸衰竭患者15例，常规单机机械通气治疗失效后通过双腔气管插管应用两台呼吸机分别与患侧肺（损伤重）和健侧肺（损伤轻或无损伤）连接实施DLV，观察DLV前及DLV后12 h、24 h、36 h呼吸力学、血流动力学、氧合指标变化。结果 DLV后各指标较前改善，表现为动脉血氧饱和度（SaO2）提高，24 h、36 h明显高于DLV前（P＜0．05）；氧合指数（PaO2／FiO2）改善，各时间段均明显高于DLV前（P＜0．05或P＜0．01），其中24 h、36 h明显高于12 h（P＜0．05）；肺内分流量（QS／QT）值下降，各时间段均低于DLV前（P＜0．05）；平均动脉压（MAP）提高，24 h、36 h高于DLV前（P＜0．05）；DLV前患侧肺呼气末二氧化碳分压（PETCO2）明显低于健侧肺（P＜0．05），DLV后提高，其中24 h、36 h升高明显（P＜0．05）；DLV前患侧肺静态顺应性（Cst）明显低于健侧肺（P＜0．05），DLV后三个时间段均明显高于DLV前（P＜0．05），其中36 h高于12 h（ P＜0．05）；DLV 前健侧肺死腔量／潮气量（ VD／VT ）比值明显高于患侧肺（ P＜0.05），DLV后三个时间段均明显下降（P＜0．05）；DLV前患侧肺气道阻力（Raw）明显高于健侧肺（P＜0．05），DLV后三个时间段均明显下降（P＜0．05或P＜0．01），其中24 h、36 h低于12 h（P＜0．05）。结论对于传统单机通气治疗失效的严重非对称性肺损伤患者，应用DLV后可能改善病情。

Objective To discuss the effect of differential lung ventilation （ DLV） for treatment of severe asymmetric lung injury .Methods Fifteen cases of asymmetric lung injury leading to acute respiratory failure failed to conventional single -ventilation were selected , DLV started through two ventilators connected to bad （ serious damaged ） and good （ light or no damaged ） lung respectively after double lumen endotracheal intubation .Respiratory mechanics , hemodynamics and oxygenation index change were observed before ventilation and 12 h, 24 h and 36 h after ventilation .Results The related indicators were improved after DLV .Arterial oxygen saturation （ SaO2 ） increased after DLV , 24 h and 36 h value was significantly higher than previously （95 ±2, 97 ±2 vs 86 ±4, P〈0.05）.Oxygenation index （PaO2/FiO2 ） was improved, all time points were significantly higher than before （168 ±32, 253 ±41, 271 ±38 vs 126 ±29, P〈0.05 or P〈0.01）, 24 h and 36 h value was significantly higher than 12 h （253 ±41, 271 ±38 vs 168 ±32, P 〈0.05）.Pulmonary shunt （QS/QT） value was decreased, all time points were lower than before （16 ±4, 12 ±4, 10 ±3 vs 39 ±5, P〈0.05）.Mean arterial pressure （MAP） was improved, 24 h and 36 h value was higher than before （80 ±17, 85 ±18 vs 68 ±15, P〈0.05）.The bad lung pressure of end -tidal carbon dioxide （PETCO2） was significantly lower than that of good lung before DLV （10 ±3 vs 25 ±2, P〈0.05）, it increased significantly in 24 h and 36 h （18 ±4, 22 ±2 vs 10 ±3, P 〈0.05）.The bad lung static lung compliance （Cst） was＆amp;nbsp;significantly lower than that of good lung before DLV （19.3 ±5.8 vs 42.6 ±6.7, P〈0.05）, three time points were significantly higher than before （32.1 ±6.3, 37.9 ±5.9, 41.5 ±6.7 vs 19.3 ±5.8, P〈0.05）, 36 h value was higher than 12 h （41.5 ±6.7 vs 32.1 ±6.3, P〈0.05）.The good lung dead space/tidal volume （VD/VT） ratio was significantly higher than that of bad lung before DLV （0.65 ± 0.12 vs 0.31 ±0.10, P〈0.05）, three time points were significantly lower than before （0.42 ±0.13, 0.36±0.11, 0.38 ±0.13 vs 0.65 ±0.12, P〈0.05）.The bad lung airway resistance （Raw） was significantly higher than that of good lung before DLV （25.7 ±2.2 vs 8.2 ±1.6, P〈0.05）, three time points were significantly lower than before （19.1 ±1.7, 10.6 ±2.0, 9.0 ±2.3 vs 25.7 ±2.2, P〈0.05 or P〈0.01）, 24 h and 36 h value was lower than 12 h （10.6 ±2.0, 9.0 ±2.3 vs 19.1 ±1.7, P〈0.05）.Conclusion DLV may improve condition in patients diagnosed severe asymmetric lung injury failed to conventional single -ventilation.