单肺通气低氧血症综合防治进展2010_培训课件.pptVIP

* Intravenous versus inhalation anaesthesia for one-lung ventilation. Bassi A, Milani WR, El Dib R. 1: Cochrane Database Syst Rev. 2008 , 16;(2):CD006313. AUTHORS CONCLUSIONS: There is no evidence from randomized controlled trials of differences in patient outcomes for anaesthesia maintained by intravenous versus inhalational anaesthesia during one-lung ventilation. * 七、血管活性药物的选择 α-受体阻滞剂 β-受体激动剂 硝酸甘油 可降低肺血管阻力，抑制HPV 应在单肺通气中慎重使用。 * 多巴酚丁胺是一个较好的选择 * 八、其他药物的影响 沐舒坦 术后病人肺不张发生率明显减少 动脉血氧分压更少降低 较少病人需要氧疗 沐舒坦具有保护肺泡表面活性物质和促进其合成的作用。 Marcatili等 * 八、前列腺素E1的影响 前列腺素E1 在肺动脉主干，选择性注射前列腺素E1，可以减少肺内分流，提高动脉血氧分压，并且与剂量成正相关性。 因此选择性动脉注射PG E1(0.04-0.4ug/kg/min),对于存在低氧血症的单肺通气病人是一种即实用且有效的方法 Chen-TL等 * 小 结 预防(上工治未病) 始终用支纤镜保证位置正确 正确的麻醉方法 合适的体位 选择对HPV影响小药物 治疗 非通气侧： CPAP、 HFJV ，N2O等低氧气体 通气侧： PEEP NO 双肺通气 * 谢 谢! 广州中医药大学第一附属医院 * 讲完了没有啊~我受不了了! 啊------ * * 2、吸入一氧化氮(NO)及静脉用Almitrine NO 研究表明：NO有舒张肺血管床的作用， 已证明 ARDS的病人吸入低浓度NO（10ppm）能有效地提高氧合 机制: 可能是增加肺泡通气良好区域的血流，减少肺内分流。 Almitrine 作用于颈动脉体化学感受器,兴奋呼吸,加强肺泡-毛细血管的气体交换,提高血氧分压. * The effects of inhaled nitric oxide and its combination with intravenousalmitrine on Pao2 during one-lung ventilation in patients undergoingthoracoscopic procedures.Anesth Analg. 1997 Nov;85(5):1130-5. The aim of this study was to assess whether hypoxemia during one-lung ventilation (OLV) can be prevented by inhaled nitric oxide (NO) (Part I) or by its combination with intravenous (IV) almitrine (Part II) in 40 patients . In Part I, 20 patients were divided intotwo groups: one received O2 (Group 1) ,one received O2/NO (Group 2). In PartII, 20 patients were divided into two groups: one received O2 (Group 3) ,one received O2/NO/almitrine (Group 4). In Groups 2 and 4, NO (20 ppm) was administered during the entire period of OLV, and almitrine was continuousl