定压及定容单肺通气模式在肺切除术中对肺呼吸生理影响.docVIP

定压及定容单肺通气模式在肺切除术中对肺呼吸生理影响 　 作者：程先进　温莉　张苏迅　刘韧　陈东生　吴晓智 【摘要】 　　目的 观察术前肺功能正常的肺切除术患者在单肺通气(OLV)期间，术侧肺采用定压控制通气模式（PCV）和定容控制通气模式（VCV）对气道压力和动脉血气值的影响。方法 选择57例术前肺功能正常或基本正常进行肺部手术的病人，随机分为A、B两组。A组：单肺通气采用VCV模式30 min 后转换为PCV模式。B组：单肺通气采用PCV模式30 min 后转换为VCV模式。分别在单肺通气期间每种模式结束后测量气道压力和动脉血气分析。结果 A组和B组在单肺通气期间动脉血氧分压（PaO2）分别为（206.1 ± 62.4）mmHg 和（202.1±56.4）mmHg ，两组相比无统计学意义（P= 0.534），A组最高气道压力比B组低(24.43 ± 3.42）cmH2O 和（34.16± 5.21）cmH2O，（Plt;0.001）。结论 肺功能正常的患者在OLV期间，PCV模式与VCV模式比较并不能提高氧合作用，但PCV模式气道压力低，有利于减少气道损伤。 【关键词】 单肺通气；定压控制通气；定容控制通气；动脉血气分析；最高气道压力 　　Abstract： Objective To evaluate the effect of pressurecontrolled ventilation (PCV) and volumecontrolled ventilation (VCV) on the arterial oxygenation and airway pressure during one lung ventilation (OLV) in lung lobectomy patients with good preoperative pulmonary function. Methods Fiftyseven patients with good preoperative pulmonary function scheduled for lung lobectomy were prospectively randomized into two groups. Those in Group A underwent OLV initially with VCV for 30 min followed by PCV for a similar period of time, and those in Group B underwent OLV initially with PCV for 30 min followed by VCV for a similar duration. Airway pressures and arterial blood gases were obtained during OLV at the end of each ventilation mode. Results There were no differences during OLV in arterial oxygenation between VCV (206.1±62.4 mm Hg) and PCV (202.1±56.4 mm Hg) (P=0.534). The peak airway pressure was lower with PCV (24.43±3.42 cm HO2) than with VCV (34.16±5.21 cm HO2) (Plt;0.001). Conclusion The use of PCV during OLV does not lead to improved oxygenation during OLV compared with VCV for the patients with good preoperative pulmonary function, but PCV dose lead to lower peak airway pressures. 　　Key words： onelung ventilation; pressurecontrolled ventilation; volumecontrolled ventilation; arterial blood gas; airway pressures 肺切除术中单肺通气(onelung ventilation，OLV)可防止病侧肺的分泌物或血液流入对侧肺，确保气道通畅，避免交叉感染或病灶扩散，同时为手术创造有利条件。但OLV常可引起较严重的低氧血症，国内外许多采用压力控制通气（pressure-contr