选择性肺叶隔离通气与单肺通气对每搏量变异度影响的比较

Comparison of effects on stroke volume variation during ventilation with selective lobar collapse and one-lung ventilation

目的探讨选择性肺叶隔离通气(SLC)和单肺通气(OLV)对胸腔镜手术患者每搏量变异度(SVV)的影响。方法择期行胸腔镜下段食管癌或贲门癌根治术患者60例,采用随机数字表法分为单肺通气对照组(OLV组)和选择性肺叶隔离通气组(SLC组)。OLV组患者采用支气管封堵器实施左肺隔离行右肺单肺通气;SLC组患者采用支气管封堵器实施左下肺叶隔离行右肺+左上肺叶通气。术中维持血氧饱和度(SpO_2)和呼气末二氧化碳(P_(ET)CO_2)在正常范围,在以下四个时间点记录SVV、心排血量(CO)、每搏输出量(SV)、收缩压(SBP)、舒张压(DBP)、心率(HR)、心脏指数(CI)等:麻醉后平卧位双肺通气10 min(T1),转侧卧位后双肺通气10 min(T_2),进胸后行单肺通气或选择性肺叶隔离通气10 min(T_3)和术毕关胸前双肺通气10 min(T_4)。结果组间比较:OLV组及SLC组患者HR、SBP、DBP、CO、CI、SV及SVV在各时点均没有明显差异(P>0.05)。组内比较:OLV组及SLC组患者SBP、DBP在T_3时较T_1时明显增高(P<0.05)。OLV组及SLC组患者SVV在T_3、T_4时较T_1时明显降低(P<0.05)。结论在胸腔镜手术中OLV和SLC下对Vigileo监测的SVV无显著差异,SVV可以用来动态监测SLC通气时的容量状况。

Objective To evaluate the effects on Stroke Volume Variation(SVV)during ventilation with selective lobar collapse(SLC)and one-lung ventilation(OLV)in thoracoscopic operation.Methods 60 patients scheduled for thoracoscopic operation to treat lower thoracic esophageal cancer or cardial carcinoma were randomly assigned into two groups:patients in one lung ventilation(OLV)group received right lung ventilation and left lung collapses,patients in selective lobar collapse(SLC)group received right lung and superior lobe of left lung ventilation by the use of endobronchial blocker.The intraoperative blood oxygen saturation(SpO2)and end-tidal carbon dioxide tension(PETCO2)were maintained in normal range.Record SVV,cardiac output(CO),stroke volume(SV),systolic blood pressure(SBP),diastolic blood pressure(DBP),the heart rate(HR),cardiac index(CI)at four time points:10 min after two lung ventilation in supine position(T1),10 min after two lung ventilation in lateral position(T2),OLV or SLC for 10 min after the pleura was opened(T3),two lung ventilation for 10 min before the pleura was closed(T4).Results There was no statistically significant difference between the two groups(P>0.05).Comparison between groups:There was no significant difference between the patients in OLV group and SLC group,including HR,SBP,DBP,CO,CI,SV and SVV(P>0.05).Comparison in the group:SBP and DBP in OLV group and SLC group were significantly higher than T1 at T3(P<0.05).The SVV of OLV group and SLC group was significantly reduced at T3 and T4(P<0.05).Conclusion There was no significant difference in SVV monitoring of Vigileo monitoring with OLV and SLC in thoracoscopic operation.SVV can be used to monitor blood volume state during ventilation by SLC.