开胸手术单肺通气时行PEEP及CPAP对氧合作用影响及麻醉管理.docVIP

开胸手术单肺通气时行PEEP及CPAP对氧合作用影响及麻醉管理 　【关键词】 呼气末正压通气；连续气道正压通气；开胸手术;单肺通气;氧和作用;分流；麻醉管理 　　［摘 要］ 目的：评价开胸单肺通气麻醉时行呼气未正压通气(PEEP)和连续气道正压通气(CPAP)对患者血氧合作用的影响。方法：选择40例开胸行肺叶切除的单纯肺癌患者，随机分为A、B两组。A组于手术开始后15 min(A1)，单肺通气后15 min(A2)，患侧肺0 cmH2O PEEP健侧肺5 cmH2O PEEP后15 min(A3)、患侧肺5 cmH2O CPAP健侧肺0 cmH2O PEEP后15 min(A4)、患侧肺5 cmH2O CPAP健侧肺5 cmH2O PEEP后15 min(A5)。分别监测平均动脉压(MAP)、心率(HR)、动脉血氧分压(PaO2、混合静脉血氧分压(PvO2)、动脉血氧饱和度(SaO2)、混和静脉血氧饱和度(SvO2)，计算分流值（Qs/Qt)。B组用10 cmH2O PEEP和10 cmH2O CPAP重复上述过程。结果：与A2相比，A3、A4和A5 PaO2显著增加，Qs／Qt值显著降低(Plt;0．05)，但A3、A4、A5间相比较差异则无显著性（Pgt;0.05)。B组各时点的各项指标变化与A组类同。结论：在开胸行单肺通气麻醉时，健肺使用PEEP、患肺使用CPAP或联合使用PEEP和CPAP，能提高患者手术中的氧合作用，降低Qs／Qt值，与5 cmH2O PEEP和CAMP比较，10 cmH2O PEEP和CPAP不能进一步改善PaO2和Qs／Qt。麻醉管理应采取措施，预防低氧血症。 　　［关键词］ 呼气末正压通气；连续气道正压通气；开胸手术;单肺通气;氧和作用;分流；麻醉管理 　　The Effect of PEEP and CPAP On the Oxygenation During One―lung Ventilation and Anesthesia Menagement in Chest opened Surgery 　　　Abstract：Objective To evaluate the effect of PEEP and CPAP on the oxygenation during one Lung ventilation in chest opened surgery．Methods Forty patients with lung cancerwere random1y divided into groups A and B．In group A，arterial xygenation，shunt fracti on and hemodynami cs were monitoted at 15 min after thestart of operation(A1)，15 min after one―lung ventilation(A2)，15 min after 0 cmH2O CPAP to the nondep endentlung and 5 cmH2O PEEP to the dependentlung(A3)，15 min after 5 cmH2O CPAP to the nondependent Lung and 0 emH2O PEEP to the dependent lung(A4)15 min after 5 cmH2O CPAP to thenondependent lung and the 5 cmH2O PEEP to the dependent lung(A5)In group B，with apptication of 10 cmH2O CPAP and 10 cmH2O PEEP instead of 5 cmH2O as in group A．Results Arterial partial pressure of oxygen(PaO2) increased and shunt fraction(Qs／Qt) valuesdecreased significanely after application of PEEP，CPAP，and combination of PEEP and CPAP in both group A and B(Plt;0．05)．There were no significant difference in PaO2 and Qs／Qt between group A and B.Conelusion The application of PEEP to the dependent lung，CPAP to the nondepen