单肺小潮气量通气最佳PEEP在肺叶切除患者的应用研究

The Applied Research of the Best PEEP for OLV With Small Tidal Volume on Patients Undergoing Pulmonary Lobectomy Surgery

目的探讨单肺小潮气量通气时的不同PEEP值在肺叶切除术患者应用的对比研究。方法选择60例肺叶切除患者,ASA分级Ⅰ~Ⅱ级,按数字表法将患者分为3组,每组20例。A组(PEEP=0)、B组(PEEP=5 cm H2O)和C组(PEEP=10 cm H2O),单肺通气时的潮气量均为5 mL/kg。观察记录双肺通气后15 min(T1)和单肺通气后15、30、45、60 min(T2~T5)5个时间点的动态肺顺应性、氧合指数(PaO2/FiO2)、术后第3天的胸部X线阳性率和肺感染评分(mCPIS)的分数。结果C组T2~T5的动态顺应性均高于A组,C组T3~T5的动态顺应性均高于B组,差异有统计学意义(P<0.05);C组T3~T5的PaO2/FiO2比A组和B组升高(P<0.05)。C组术后第3天的胸部X线阳性率和肺感染评分(mCPIS)的分数比A组和B组降低(P<0.05或P<0.01)。结论单肺小潮气量通气PEEP=10 cm H2O时,可明显改善单肺通气期间的肺动态顺应性,提高氧合指数,利于术中麻醉管理与患者早日康复。

Objective To investigate the comparative study of the application of different end-expiratory pressure(PEEP) with one-lung ventilate(OLV) used small tidal volume(VT) on lobectomy patients. Methods Select 60 cases of with ASA Ⅰ~Ⅱ for lobectomy of lung, in accordance with the random number table method were divided into 3 groups with 20 cases in each group. The tidal volume in group A(PEEP=0), group B(PEEP=5 cm H2 O) and group C(PEEP=10 cm H2 O) was 5 m L/kg for OLV. The patients 5 time points of the dynamic lung compliance, the oxygenation index(PaO2/Fi O2) at 15 min of two-lung ventilate(T1) and after 15, 30, 45, 60 min of OLV(T2-T5), the positive rate of chest X-rays and the score of m CPIS the third day after surgery were observed and recorded. Results The dynamic compliance of T2-T5 in group C was higher than that in group A, and that of T3-T5 in group C was higher than that in group B, and the difference was statistically significant(P < 0.05). The PaO2/FiO2 of T3~T5 time points in group C was higher than that in group A and group B(P < 0.05). The positive rate of chest X-rays and the score of m CPIS on the third day after surgery in group C were lower than those in group A and group B(P < 0.05 or P < 0.01).Conclusion When PEEP=10 cm H2O with small tidal volume can significantly improve the dynamic lung compliance and oxygenation index during one-lung ventilation. It is beneficial to management of anesthesia during operation and also can be making the patient recovery early.