选择性肺叶通气用于肺功能欠佳患者胸科手术的临床效果

Clinical efficacy of ventilation with selective lobar collapse for thoracic surgery in patients with pulmonary dysfunction

目的:比较肺功能欠佳的患者在胸科手术中由单肺通气改行选择性肺叶通气后,患者呼吸力学和氧合情况的变化。方法:选择10例择期经胸手术患者,均采用支气管封堵法肺隔离单肺通气,因无法纠正的低氧血症改行选择性肺叶通气,Ⅰ期:单肺通气;Ⅱ期:选择性肺叶通气。比较前后不同通气方式下气道峰压(Ppeak)、气道平台压(Pplat)的水平,通过动脉血血气分析结果,比较动脉氧分压(PaO_2)、动脉CO_2分压(PaCO_2)、动脉血氧饱和度(SaO_2)、肺泡-动脉氧分压差[P(A-a)O_2],计算氧合指数(OI)、呼吸指数(RI)。并记录胸内手术时间及术后气道异常情况。结果:与Ⅰ期相比,Ⅱ期Ppeak、Pplat、RI降低(P<0.05),OI升高(P<0.05);Ⅱ期动脉血气分析PaO_2、SaO_2升高(P<0.05),PaCO_2、P(A-a)O_2降低(P<0.05)。与同期同类型病例比较,手术时间及术后气道并发症发生率差异无统计学意义(P>0.05)。结论:选择性肺叶隔离可明显提高氧合,更好地保护肺功能,对经胸食道手术和下肺手术有良好的适应证,尤其适用于术前肺功能欠佳的患者。

Objective ： Compare the changes of respiratory mechanics and oxygenation data in patients with pulmonary dys function,to investigate the clinical efficacy of ventilation from one lung ventilation to selective lobar collapse during thoracic surgery. Methods ：The method proceed with review analysis of the 10 patients undergoing selective thoracic surgery. Because of hypoxemia cannot be corrected during the surgery, the ventilation pattern had to be changed from one lung ventilation to selecive lobar ventilation. Group ⅠⅠ： one lung ventilation, Group Ⅱ ： selective lobar ventilation. In Group I and Group Ⅱ, airway peak pressure（ Ppeak）, plat pressure （Pplat） were recorded. By arterial blood gas analysis results, arterial oxygen partial pressure （ PaO2 ） , Partial Pressure of Oxygen （ PaCO2 ） , arterial oxygen saturation （ SaO2 ） , difference of alveoli - arterial oxygen pres [ P（ A - a） O2 ） ] were compared. Oxygenation index（OI） and respiratory index（RI） were calculated. The operation time and postoperative complications of the airway were recorded. Results ： Ppeak, Pplat, PaCO2, P （ A - a） O2 and RI were significantly lower in group Ⅱ（P 〈 0.05 ）, while PaO2, SaO2 and Ol were significantly higher in group Ⅱ （P 〈 0.05）. There were no significant differences in operation time and airway complication rate after the surgery. Conclusion：The thoracic operation can be more safely by using ventilation with selective lobar collapse, however, ventilation with selective lobar collapse can improve oxygenation and provides better ventilatory efficacy than one lung ventilation in patients with pulmonary dysfunction.