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首页> 中文期刊> 《中国现代医学杂志》 >不同吸气末停顿及吸呼比对胸科手术单肺通气患者呼吸功能的影响

不同吸气末停顿及吸呼比对胸科手术单肺通气患者呼吸功能的影响

         
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目的 探讨需单肺通气(OLV)的胸科手术中不同吸气末停顿(EIP)及吸呼比对患者呼吸功能的影响.方法 选择该院择期行胸科手术OLV患者60例,根据随机数字表法将其分为OLV吸呼比1:2组(A组)和OLV吸呼比1:1组(B组),每组30例.将两组根据吸气末停顿设置的不同分别随机分为2个亚组,即OLV后吸呼比1:2,吸气末停顿0％、10％、20％ 先后通气30 min组(A1组);吸气末停顿0％、20％、10％先后通气30 min组(A2组);OLV后吸呼比1:1,吸气末停顿0％、10％、20％ 先后通气30 min组(B1组);吸气末停顿0％、20％、10％ 先后通气30 min组(B2组).每组15例.分别于OLV前(T1)、OLV后30 min(T2)、60 min(T3)、90 min(T4)记录患者血流动力学指标、呼吸力学指标并采集动脉及中心静脉血进行血气分析.结果 在A组与B组中,吸气末停顿20％ 与吸气末停顿0％、10％ 比较,患者动脉血二氧化碳分压(PaCO2)、死腔率降低(P<0.05).B组在联合吸气末停顿0％、10％、20％ 时与A组比较,患者气道压峰值、平台压降低,肺顺应性提高(P<0.05).结论 对胸科手术OLV患者,吸气末停顿20％ 有利于二氧化碳交换,减少死腔率;吸呼比1:1可降低气道压,提高肺动态顺应性.两者对患者血流动力学指标无影响.%Objective To investigate the effects of different end-inspiratory pause (EIP) and ratio of inspiration to expiration (I: E) on respiratory function in patients undergoing thoracic surgery with one-lung ventilation (OLV). Methods A total of 60 patients undergoing thoracic surgery with one-lung ventilation in our hospital were randomly divided into two groups:patients receiving I : E of 1 : 2 group (group A), and patients receiving I : E of 1 : 1 group (group B) (n = 30). Inside each group, patients were randomly divided into 2 subgroups (subgroup A1, A2 and B1, B2) (n = 15). Patients in subgroup A1 were ventilated for 30 min with EIP in order of 0％, 10％ and 20％. Patients in subgroup A2 were ventilated for 30 min with EIP in order of 0％, 20％ and 10％. Patients in subgroup B1 were ventilated for 30 min with EIP in order of 0％, 10％ and 20％. Patients in subgroup B2 were ventilated for 30 min with EIP in order of 0％, 20％ and 10％. Hemodynamics, respiratory parameters and arterial/central venous blood gas were recorded at baseline (T1), 30 min (T2), 60 min (T3), and 90 min (T4). Results Patients in both group A and group B with the EIP of 20％ experienced downregulated levels of arterial CO2 partial pressure and the dead space rate compared with that in groups of the EIP as 0％ and 10％ (P < 0.05). Ppeak and Pplat were significantly decreased while pulmonary dynamic compliance was increased in group B when compared with group A (P < 0.05). Conclusion For patients undergoing thoracic surgery with one-lung ventilation, EIP of 20％ and I : E of 1 : 1 is more appropriate for CO2 exchange, reduction of dead space rate and airway pressure and improvement of pulmonary dynamic compliance.

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