反比通气对单肺通气婴幼儿肺功能的影响

Effect of inverse ratio ventilation on lung function in infants received one lung ventilation

目的探讨反比通气(IRV)对单肺通气(OLV)婴幼儿肺功能影响。方法选取择期拟行胸腔镜下肺囊腺瘤切除术的婴幼儿64例,随机分为常规通气组(C组)和反比通气组(I组),每组32例,I组OLV期间调整I∶E为1.5∶1,C组不变,于双肺通气(TLV)10 min(T_1)、OLV 30 min(T_2)、OLV 60 min(T_3)、恢复TLV 30 min(T_4),记录血流动力学和呼吸力学指标,同时进行血气分析。于术前和术后进行支气管肺泡灌洗,收集灌洗液,检测IL-6、IL-8的表达水平。结果与T1相比,两组患儿T_2～T_4时Ppeak、Pmean、Pplat升高(P <0.05),PaO_2、IO、Cdyn下降(P <0.05);与C组比较,I组Pmean、PaO_2、IO、Cdyn升高(P <0.05),Ppeak,Pplat则降低(P <0.05),T_1、T_2和T_4时两组PaCO_2,pH值差异无统计学意义(P> 0.05),T3I组与C组相比PaCO_2升高,pH值下降(P <0.05),Lac两组差异无统计学意义(P> 0.05)。两组患儿术后IL-6、IL-8较术前增高(P <0.05),I组比C组降低(P <0.05)。结论婴儿实施OLV时采用IRV可以降低术中气道峰压,改善氧合,增加肺顺应性,并有一定的肺保护作用。

Objective To investigate the effect of inverse ratio ventilation(IRV)on lung function in infants received one lung ventilation(OLV).Methods 64 infants to receive thoracoscopic resection of pulmonary cystadenoma were randomly divided into convention ventilation group(Group C,n=32)and inverse ratio ventilation group(Group I,n=32).The single lung ventilation(OLV)period plan,I∶E of Group I was changed into 1.5∶1,but Group C remained the same.The hemodynamics and respiratory mechanics indexes and blood gas analysis at four points,TLV 10 min(T1),OLV 30 min(T2),OLV 60 min(T3),and TLV 30 min(T4),were recorded.Bronchoalveolar lavage was performed before and after the operation,and lavage fluid was collected to detect the expression levels of IL-6 and IL-8.Results Compared with T1,Ppeak,Pmean and Plat increased in the two groups(P﹤0.05),while PaO2,IO,Cdyn decreased(P﹤0.05),and PaCO2 increased at T2~T3(P﹤0.05)from T2 to T4,no obvious difference was found at T4.Compared with group C,HR and MAP in group I was not significantly different(P﹥0.05),but Pmean,IO,Cdyn increased(P﹤0.05),and Ppeak,Plat decreased(P﹤0.05).PaCO2,pH had no significant difference at T1,T2 and T4 in both groups(P﹥0.05),but was higher,at T3.Meanwhile,pH was lower in Group I than in Group C(P﹤0.05),and Lac was not significantly different between the two groups(P﹥0.05).IL-6 and IL-8 of the two groups were higher than before operation(P﹤0.05).Conclusion IRV can reduce peak airway pressure,improve oxygenation and increase lung compliance in infants undergoing OLV.