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小潮气量不同通气方式在开胸手术单肺通气时的临床疗效 预览

Clinical efficacy of different ventilatory patterns in low tidal volume during one-lung ventilation
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摘要 目的观察小潮气量复合呼气末正压通气(PEEP)和连续气道正压通气(CPAP)在开胸手术单肺通气时气道管理的效果。方法择期行肺叶切除术的患者90例,ASAⅠ~Ⅱ级,单肺通气时在保证每分钟通气量不变的情况下,按不同的通气方式分为3组,每组30例。Ⅰ组全潮气量通气[潮气量(VT)10mL/kg,呼吸频率(RR)12bpm],Ⅱ组小潮气量复合健侧肺PEEP(VT 6mL/kg,RR 20bpm,PEEP 5mm H2O),Ⅲ组小潮气量复合健侧肺PEEP和患侧肺CPAP(VT 6mL/kg,RR 20bpm,PEEP 5mm H2O,CPAP 4mm H2O)。在双肺全潮气量通气30min后(T0)、单肺通气30min后(T1)、恢复双肺通气30min后(T2),记录平均动脉压(MBP)、心率(HR)和气道锋压(Ppeak)变化,并分析氧分压(PaO2)、二氧化碳分压(PaCO2)变化。结果与Ⅰ组比较,Ⅱ、Ⅲ组T1时PaO2和PaCO2明显升高(P<0.05),Ppeak明显下降(P<0.05),MBP、HR无明显变化(P>0.05)。与Ⅱ组比较,Ⅲ组在T1时PaO2明显升高(P<0.05),其余指标差异无统计学意义(P>0.05)。3组患者麻黄碱、阿托品使用例次差异无统计学意义(P>0.05)。结论单肺通气时小潮气量复合PEEP和CPAP可改善动脉氧合,降低Ppeak。 Objective To observe the efficacies of airway management in low tidal volume combined with PEEP and CPAP during one-lung ventilation for thoracotomy.Methods Ninety ASAⅠ-Ⅱpatients undergoing elective pulmonary lobectomy were selected and randomly divided into three group according to different ventilationary patterns while ensuring minute ventilation volume unchanging,30cases in each group.The groupⅠwas given the full tidal ventilation(VT=10mL/kg,RR=12bpm),the groupⅡwas given the small tidal volume combined PEEP in unjured side lung(VT=6mL/kg,RR=20bpm,PEEP 5mm H2O)and the groupⅢwas given the small tidal volume combined PEEP in unjured side lung and CPAP in injured lung(VT=6mL/kg,RR=20bpm,PEEP 5mm H2O and CPAP 4mm H2O).The changes of mean arterial blood presseure(MBP),HR and airway peak pressure(Ppeak)at 30min after double-lung full tidal volume ventilation(T0),30min at one-lung ventilation(T1)and 30min after double lungs ventilation recovery(T2)were recorded.Moreover the changes of PaO2and PaCO2 were analyzed.Results Compared with the groupⅠ,PaO2and PaCO2at T1in the groupⅡandⅢwere significantly increased(P<0.05),but Ppeak was significantly decreased(P<0.05)and MBP and HR had no significant difference(P>0.05).Compared with the groupⅡ,PaO2at T1in the groupⅢwas significantly increased(P<0.05),and the other indexes had no statistically significant difference(P>0.05).Conclusion During one-lung ventilation,low tidal volume combined PEEP and CPAP can improve the arterial oxygenation and decrease the airway peak pressure.
作者 王雁 杨渊 WANG Yan;YANG Yuan(Department of Anesthesiology,First Affiliated Hospital,Kunming Medical University,Kunming,Yunnan 650032,China)
出处 《重庆医学》 CAS 2019年第6期987-989,992共4页 Chongqing medicine
关键词 潮气量 单肺通气 正压呼吸 tidal volume one-lung ventilation positive-pressure respiration
作者简介 王雁(1980-),主治医师,硕士,主要从事临床麻醉研究;通信作者:杨渊,E-mail:wangyanynkm@sina.com.
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