食管癌胸腹腔镜联合根治术非通气侧肺实施持续气-第三军医大学学报.docVIP

持续气道正压通气对胸腹腔镜下食管癌根治术患者单肺通气时肺内分流和氧合的影响 李琪英，闵 苏 （400016 重庆重庆医科大学附属第一医院麻醉科）目的 观察胸腹腔镜下食管癌根治术患者单肺通气( one lung ventilation，OLV)时非通气侧肺持续气道正压(Continuous Positive Airway Pressure，CPAP)通气对肺内分流和氧合的影响。方法 80例择期行胸腹腔镜下食管癌根治术患者，ASA分级Ⅰ～Ⅱ级，分为4组（n=20）：对照组单肺通气时非通气侧支气管导管与大气相通；2cmH2O组、cmH2O组、cmH2O组单肺通气时非通气侧肺分别给予2、5、8 cmH2O的CPAP处理。分别于单肺通气前、单肺通气30 min、60 min、90 min、120 min血气分析，根据公式计算肺内分流率（Qs/Qt）。结果 对照组和CPAP 2H2O组～Qs/Qt较明显增高，氧分压（PaO2）明显降低 ( P0.05)；CPAP 5H2O组和CPAPH2O组～Qs/Qt较亦有增加，PaO2亦有降低，但差异无显著性(P0.05)；～，CPAP 5H2O组、CPAPH2O组Qs/Qt明显低于对照组和CPAP H2O组，PaO2明显高于对照组和CPAP H2O组( P0.05)，而 CPAP 5H2O组与CPAP H2O组在上述各时点Qs/Qt、PaO2无统计学差异(P0.05)。CPAP 2cmH2O组CPAP 5cmH2O组手术侧肺萎陷优于CPAP H2O组。结论 胸腹腔镜下食管癌根治术患者单肺通气时对非通气侧肺实施5cmH2O和8cmH2O的CPAP可减少肺内分流，明显提高PaO2，防止低氧血症的发生；5cmH2O的CPAP有利于术野暴露，满足手术操作。 关键词 持续气道正压通气；；食管癌Effects of continuous positive airway pressure on the oxygenation and shunt fraction during one-lung ventilation in thoracoscopy and laparoscopy for esophageal carcinoma Li Qiying Min Su （Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University） [Abstract] Objective: To evaluate the effects of continuous positive airway pressure (CPAP) for non-ventilated lung on the oxygenation and shunt fraction during one-lung ventilation (OLV) in thoracoscopy and laparoscopy for esophageal carcinoma. Methods: 80 ASAⅠ-Ⅱesophageal cancer patients scheduled for esophagectomy with thoracoscopy and laparoscopy for esophageal carcinoma were enrolled and randomly divided into 4 groups (n=20): Controlled group, CPAP 2cmH2O group, CPAP 5cmH2O group and CPAP 8cmH2O group. The non-ventilated lung was kept open to the air during OLV in controlled group, while 2cmH2O, 5cmH2O, 8cmH2O CPAP was administered to the non-ventilated lung during OLV in CPAP 2cmH2O group, CPAP 5cmH2O group, CPAP 8cmH2O group respectively. Blood gases of all patients were analyzed separately before OLV (T1), 30 min OLV (T2), 60min OLV (T3), 90min OLV (T4), 120min OLV (T5) to calculate the shunt ratio (Qs/Qt). Results: Compared wi