不同压力的持续气道正压对化疗后病人单肺通气氧合与分流的影响

Effects of non-ventilated lung insufflated with continuous positive airway pressure on systemic oxygenation and intrapulmonary shunt during one lung ventilation

目的 探讨应用一种新的持续气道正压 (CPAP)系统在肺癌病人化疗后单肺通气(OLV)时对病人氧合和肺内分流的影响。方法 择期手术病人 30例 ,ASAⅠ～Ⅲ级 ,随机分为对照组 (A组 )、CPAP 2组 (B组 )和CPAP 5组 (C组 ) ,每组 1 0例。A组在OLV期间非通气侧肺的支气管导管直接开口于大气中 ;B组OLV期间非通气侧持续给予CPAP(压力 2cmH2 O) ,C组OLV期间非通气侧持续给予CPAP(压力 5cmH2 O) ,并在平卧双肺通气 2 0min ,仰卧OLV 2 0min ,侧卧OLV2 0、4 0min和关胸双肺通气时 ,分别采取动脉血行血气分析并计算肺内分流率 (Qs/Qt)。结果在OLV后 2 0、4 0min时 ,B、C两组氧合明显高于A组 (P <0 .0 1 ) ,B、C两组Qs/Qt明显低于A组 (P<0 .0 5 ) ,B、C两组之间氧合和Qs/Qt仅在OLV后 4 0min时差异显著。结论 化疗后病人非通气侧持续CPAP ,有助于提高氧合 ,减少肺内分流 ,减少低氧血症的发生率 ,且CPAP 2cmH2

Objective To investigate the effects of non ventilated lung with CPAP of different levels on systemic oxygenation and intrapulmonary shunt during one lung ventilation(OLV). Methods Thirty ASA Ⅰ Ⅲ patients,scheduled for selective pulmonary surgery,were randomly divided into three groups: control group (group A, n= 10),CPAP 2 group (group B, n= 10),and CPAP 5 group (group C, n= 10). The non ventilated lung was kept open to the air in group A; CPAP with O 2 2 cmH 2O or O 2 5 cmH 2O was insufflated into the non ventilated lung during OLV in group B or C respectively. The anesthesia was induced with intravenous midazolam 0 05 mg/kg,propofol 0 5 1 0 mg/kg,fentanyl 4 μg/kg,and vecuronium 0 1 mg/kg and maintained with isoflurane inhalatation. Blood gas analysis was determined at 20 min after two lung ventilation(TLV in the supine position,20 min after OLV in the supine position,20 min and 40 min after OLV in the lateral position. At the end of operation,and the shunt fraction was calculated.Results PaO 2 in group B and C was increased significantly more than that in group A( P< 0 05),and Qs/Qt in group B and C was decreased significantly more than that in group A( P< 0 05).During OLV,PaO 2 in group C was only increased significantly more than that in group B at 40 min after OLV ( P< 0 05).Conclusions Non ventilated lung insufflated with CPAP system may improve the systemic oxygenation and reduce the intrapulmonary shunt, and prevent hypoxemia in patients during one lung ventilation.