高频喷射通气治疗胸腔手术单肺通气期间低氧血症的临床观察

Effect of high-frequency jet ventilation in hypoxemia patients receiving thoracic surgery with one-lung ventilation

目的:探讨高频喷射通气治疗胸腔手术单肺通气期间低氧血症的临床效果。方法:回顾分析本院行开胸手术术中单肺通气患者中发生低氧血症患者的病历资料。所有患者采用静吸复合麻醉,常规置入支气管双腔管,使用电子支气管镜行支气管双腔管定位。手术中术侧肺开放,非术侧肺采用低潮气量(6 mL/kg)加呼气末正压PEEP(6 cmH_2O)行容量控制机械通气。对术中发生低氧血症(SpO_2≤92%)的患者给予术侧肺高频喷射通气治疗,若无改善则施行间断双肺通气。高频喷射通气频率280次/min,吸呼比1∶4或1∶5。检测高频通气前、高频喷射通气后15 min和实施双肺通气后15 min的动脉血气分析。结果:回顾胸腔手术实施单肺通气患者共计374例,其中42例发生低氧血症,发生率为11.2%。42例低氧血症患者全部接受术侧肺高频喷射通气治疗,其中30例(71.4%)治疗有效,治疗后动脉血氧分压和血氧饱和度明显改善(P﹤0.05);12例效果欠佳,实施间断双肺通气完成手术。结论:术侧高频喷射通气能够有效改善开胸手术单肺通气期间低氧血症,可在临床上选择性应用,但对高频喷射通气的通气方式、频率、吸呼比、通气量等尚需进一步研究。

Objective:To evaluate the effect of high-Frequency jet ventilation in hypoxemia patients receiving thoracic surgery with one-lung ventilation.Methods:To retrospectively analyze the medical records of patients with hypoxemia during one-lung ventilation during thoracotomy in our hospital.All the patients received intravenous-inhalation general anesthesia and double-lumen endotracheal intubation,which was located by electronic-bronchoscope.The operated lung was open in the procedure and volume-controled ventilation with low tidal volume(6 ml/kg) and low PEEP(6 cmH2O) was perfomed in the non-operated lung.The patients with hypoxemia(SpO2≤92%) were treated with high frequency jet ventilation in the non-operated lung.Intermittent bilateral ventilation was performed in case with refractory hypoxemia.The high frequency jet ventilation was perfomed with a frequency of 280/min,and an I/E ratio from 1:4 to 1:5.Arterial blood analysis was perfomed before and 15 minutes after the start of the high frequency jet ventilation or intermittent bilateral ventilation.Results:A totality of 374 patients was reviewed,of whom 42 cases suffered from hypoxemia,the incidence of hypoxemia was 11.2%.The 42 patients with hypoxemia were all treated by high frequency jet ventilation,30 of them(71.4%) were effective.The partial pressure of arterial oxygen and oxygen saturation were significantly improved after treatment(P< 0.05).12 cases were not effective,and the operation was completed by intermittent bilateral pulmonary ventilation.Conclusion:High frequency jet ventilation improves oxygenation in hypoxemia patients receiving thoracic surgery with one-lung ventilation,implying its worthful prospect in this specific patient population.Further studies are needed to comfirm its application mode,frequency,I/E ratio and ventilation volume.