三种不同通气模式时单肺通气对胸科手术患者血流动力学影响的对比研究

Comparative study on the effect of three different ventilation modes of one lung ventilation on hemodynamics in patients with thoracic surgery

目的探讨三种不同通气模式时单肺通气对胸科手术患者血流动力学的影响。方法根据通气方式不同将需行胸科手术的120例患者分为三组:容量控制通气(VCV)组、压力控制通气(PCV)组和压力控制通气-容量保证(PCV-VG)组各40例。比较三组患者术中情况并记录T1(手术前)、T2(单肺通气20分钟)、T3(单肺通气40分钟)、T4(单肺通气60分钟)、T5(术后20分钟)时三组患者心率(HR)、平均动脉压(MAP)、动脉血氧分压(PaO_2)、血氧饱和度(SaO_2)、心排出量(CO)、全身血管阻力指数(SVRI)的变化以及术中肺萎缩、术后呼吸并发症发生率。结果 PCV-VG组麻醉时间、手术时间、通气时间均比其余两组短(P<0.05);在T2、T3、T4时,PCV-VG组PaO_2水平均比其余两组高(P<0.05)。结论在胸科手术中给予PCVVG通气模式对患者血流动力学影响较小,值得应用推广。

Objective To study the effect of three different ventilation modes of one lung ventilation on hemodynamics in patients with thoracic surgery.Method 120 cases of thoracic surgery patients from August 2013 to August 2016 in our hospital were studied.The different ventilation modes were divided into three groups,volume controlled ventilation（VCV） group,pressure control ventilation（PCV） group,pressure control ventilation capacity assurance（PCVVG）group,each of the 40 cases.The operation condition of T1（before the operation）,T2（one lung ventilation20min）,T3（one lung ventilation 40min）,T4（one lung ventilation 60min）,and T5（postoperative 20min） of three groups were compared,and the three groups of patients with the change of heart rate（HR）,mean arterial pressure（MAP）.arterial partial pressure of oxygen（PaO2）,Blood oxygen saturation（SaO2）,Cardiac output（CO）,systemic vascular resistance index（SVRI） and the incidence rate of lung atrophy during operation and postoperative respiratory discomfort were recorded.Result The anesthesia time,operation time and ventilation time of PCV-VG group were shorter than the other two groups（P〈0.05）;at the T2,T3,T4,in the,the level of PaO2 in the PCV-VG group were higher than the other two groups（P〈0.05）.Conclusion Give the PCV-VG ventilation mode have a little effect of on hemodynamics in thoracic surgery,and it is worth to be popularized.