单肺通气所致肺内分流的研究

Research Progress of Intrapulmonary Shunt Caused by One-lung Ventilation

目前单肺通气技术已经广泛应用于胸科手术的麻醉。但单肺通气会导致肺内分流的骤然增加,肺内分流会引起一系列不良的影响,危害患者围手术期的安全。肺内分流量受多种因素的影响,其中缺氧性肺血管收缩(HPV)是机体主要的保护性代偿机制,增强HPV的作用和降低对HPV作用的抑制是术中改善肺内分流的关键。术中常用的多种药物会对HPV产生影响,不同的呼吸参数也会影响肺内分流的变化。本文就国内外近年来关于单肺通气所致肺内分流的不良影响、代偿机制及影响因素等进行综述,为临床实践提供理论基础,保障患者围手术期的安全。

At present,one-lung ventilation has been widely used in thoracic surgery anesthesia.However,single lung ventilation can lead to a sudden increase in pulmonary shunt,which can cause a series of adverse effects and harm the safety of patients in perioperative period.Pulmonary shunt volume is affected by many factors,among which hypoxic pulmonary vasoconstriction(HPV)is the main protective compensatory mechanism.Enhancing the effect of HPV and reducing the inhibition of the effect of HPV is the key to improve intraoperative pulmonary shunt.HPV can be affected by a variety of drugs commonly used during surgery,and different respiratory parameters can also affect changes in pulmonary shunt.In this paper,the adverse effects of one-lung ventilation induced intrapulmonary shunt,the compensatory mechanism of intrapulmonary shunt and the factors affecting intrapulmonary shunt are reviewed,which could provide theoretical basis for clinical practice and guarantee the safety of patients during perioperative period.