定压和定容单肺通气模式在肺切除术中对肺呼吸生理的影响临床医学.docVIP

定压和定容单肺通气模式在肺切除术中对肺呼吸生理的影响临床医学 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：定压和定容单肺通气模式在肺切除术中对肺呼吸生理的影响临床医学 1 1 资料与方法 3 2 结 果 4 3 讨 论 4 文2：定压和定容两种模式在老年单肺通气麻醉中的应用 6 1 资料和方法 7 2 结 果 9 3 讨 论 9 参考文摘引言： 11 原创性声明（模板） 12 文章致谢（模板） 12 正文 定压和定容单肺通气模式在肺切除术中对肺呼吸生理的影响临床医学 文1：定压和定容单肺通气模式在肺切除术中对肺呼吸生理的影响临床医学 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 (± mm Hg) and PCV (± mm Hg) (P=). The peak airway pressure was lower with PCV (± cm HO2) than with VCV (± cm HO2) (P). 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-controlled ventilation，PCV）和容积控制通气（volumecontrolled ventilation，VCV)的模式来改善OLV所致低氧血症[1]，本研究拟观察两种单肺通气模式对肺切除中呼吸生理的影响。 1 资料与方法 一般资料 57例ASA为Ⅱ~Ⅲ级的单肺通气至少需要1 h 以上的肺部切除术患者，男性35例，女性22例，平均年龄（±）岁（33~76岁），随机分为两组：A组：28例，单肺通气开始时采用VCV模式(OLVVCV)，30 min 后通气模式转换为PVW（减慢流速）；B组：29例，单肺通