肺叶隔离通气用于COPD老年患者开胸手术时通气效果.docVIP

气道管理 肺叶隔离通气用于COPD老年患者开胸手术时的通气效果 沈颖彦 周清河 杜炎芳 肖旺频 DOI：10.3760/cma.j.issn.0254-1416.2012.04.000 基金项目：浙江省嘉兴市科技局资助项目（2010AY1041） 作者单位：314000 浙江省嘉兴市嘉兴学院附属第二医院麻醉科 通信作者：肖旺频，Email：jxmzzk@ 【摘要】 目的 评价选择性肺叶隔离通气用于慢性阻塞性肺病（COPD）老年患者开胸手术时的通气效果。方法 择期行食管癌根治术合并COPD的老年患者30例，年龄65~80岁，体重指数16～28，ASA分级Ⅱ或Ⅲ级，随机数字表法将其分成单肺通气组（OLV组）和选择性肺叶隔离通气组（SLB组），每组15例。OLV组患者采用双腔气管导管实施单肺通气，SLB组患者使用支气管堵塞器堵塞肺叶支气管，实施选择性肺叶隔离通气。于平卧位双肺通气10min(T0)、侧卧位单肺通气或选择性肺叶隔离通气5min(T1)、45min(T2)、90min(T3)、术毕侧卧位双肺通气10min(T4)时测定气道峰压（Ppeak）、气道平台压（Pplat）、气道阻力（Raw）和动态肺顺应性（Cd）。于T0、T3、T4时取动脉血样2ml，行血气分析，计算氧合指数(OI)、肺泡-动脉血氧分压差[P(A-a)O2]、呼吸指数(RI)。结果 与OLV组相比，SLB组Ppeak、Pplat及Raw在T2、T3、T4时明显降低（P﹤0.01或0.05）；Cd在T1、T2、T3、T4时升高（P﹤0.05或0.01）；OI在T3、T4时升高（P﹤0.01）；RI及P(A-a)O2在T3、T4时降低（P﹤0.05或0.01）。结论　COPD老年患者胸科手术时，实施选择性肺叶隔离通气能减少呼吸力学的改变，有助于降低机械通气引起的肺损伤，改善氧合。 【关键词】 肺通气；COPD ；老年；呼吸力学；胸外手术 Effects of selective lobar blockade ventilation on respiratory mechanics and oxygenation in patients with COPD during thoracic surgery SHEN Ying-yan, ZHOU Qing-he, DU Yan-fang, XIAO Wang-pin，Department of Anesthesology,Second Affiliated Hospital, Jiaxing College, Jiaxing 314000, Zhejiang Province, China Corresponding author: XIAO Wang-pin, Email:jxmzzk@ 【Abstract】Objective To investigate the effects of lobar blockade ventilation on respiratory mechanics and oxygenation in patients with COPD during thoracic surgery. Methods Thirty ASA Ⅱ or Ⅲ lower esophageal, cancer radical correction patients were randomly divided into two groups：one-lung ventilation group(OLV group) and selective lobar blockade ventilation (SLB group), 15 case each group. The criterion of patients to be selected was Inferior segment esophageal cancer complicated with from midrange to severity pulmonary functional defect(FEVl／FVC0.7).The double-lumen endobronchial tube was placed in the OLV group, a 8.0-mm internal diameter single-lumen endotracheal tube was used in the SLB group and 9 French Coopdech blocker was advanced into the left lower lobar bronchus with the guidance of a fiberoptic bron