CAJ | 학술논문

目的探讨呼气末正压(PEEP)对单肺通气患者术中动脉氧合和肺内分流及术后肺功能的影响.方法 40例肺功能正常、ASA分级I～Ⅱ级、择期行肺叶切除术患者按随机数字表法分为对照组和PEEP组,每组20例.所有患者经静脉麻醉快速诱导后行双腔气管导管插管并双肺通气,潮气量10ml/kg,呼吸频率12次/min.开胸后改为健侧肺单肺通气,潮气量6ml/kg,呼吸频率16～18次/min.对照组无PEEP,PEEP组加用5 cm H2O(1 cm H2O=0.098 kPa)PEEP.连续监测血流动力学和呼吸力学参数,并测定术前和术后72 h肺功能.结果与单肺通气前比较,两组单肺通气30min动脉血氧分压、脉搏血氧饱和度、氧合指数均显著下降,肺内分流率(Qs/Qt)显著增加(P<0.01或<0.05),且对照组变化更显著(P<0.05).两组术后72 h第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、用力肺活量(FVC)占预计值百分比(FVC%)、FEV1/FVC均较术前显著降低[对照组术前:(121.8±25.1)%、(117 2±24.3)%、(87.6±15.7)%,术后72 h:(84.9±21.6)%、(77.2±18.3)%、(70.5±12.5)%;PEEP组术前:(116 9±24.5)%、(112.1±23.6)%、(85.3±13.8)%,术后72h:(96.3±20.4)%、(881±19 8)%、(78.4±10.2)%](P<0.01或<005),且对照组变化更显著(P(0.05).结论单肺通气期间加用适当的PEEP可增加动脉氧合、降低肺内分流、改善肺功能,从而降低围手术期患者低氧血症的发生和减轻单肺通气所致的肺损伤.
목적 탐토호기말정압(PEEP)대단폐통기환자술중동맥양합화폐내분류급술후폐공능적영향.방법 40례폐공능정상、ASA분급I～Ⅱ급、택기행폐협절제술환자안수궤수자표법분위대조조화PEEP조,매조20례.소유환자경정맥마취쾌속유도후행쌍강기관도관삽관병쌍폐통기,조기량10ml/kg,호흡빈솔12차/min.개흉후개위건측폐단폐통기,조기량6ml/kg,호흡빈솔16～18차/min.대조조무PEEP,PEEP조가용5 cm H2O(1 cm H2O=0.098 kPa)PEEP.련속감측혈류동역학화호흡역학삼수,병측정술전화술후72 h폐공능.결과 여단폐통기전비교,량조단폐통기30min동맥혈양분압、맥박혈양포화도、양합지수균현저하강,폐내분류솔(Qs/Qt)현저증가(P<0.01혹<0.05),차대조조변화경현저(P<0.05).량조술후72 h제1초용력호기용적(FEV1)점예계치백분비(FEV1%)、용력폐활량(FVC)점예계치백분비(FVC%)、FEV1/FVC균교술전현저강저[대조조술전:(121.8±25.1)%、(117 2±24.3)%、(87.6±15.7)%,술후72 h:(84.9±21.6)%、(77.2±18.3)%、(70.5±12.5)%;PEEP조술전:(116 9±24.5)%、(112.1±23.6)%、(85.3±13.8)%,술후72h:(96.3±20.4)%、(881±19 8)%、(78.4±10.2)%](P<0.01혹<005),차대조조변화경현저(P(0.05).결론 단폐통기기간가용괄당적PEEP가증가동맥양합、강저폐내분류、개선폐공능,종이강저위수술기환자저양혈증적발생화감경단폐통기소치적폐손상.
Objective To explore the effect of positive end expiratory pressure (PEEP) on arterial oxygenation and intrapulmonary shunt during one-lung ventilation (OLV) and pulmonary function during perioperation. Methods Forty patients with normal pulmonary function,ASA I - II :scheduled for pulmonary lobectomy, were divided into control group and PEEP group by random digits table with 20 cases each. Patients were induced by double-lumen tubes under intravenous anesthesia and were received 10 ml/kg tidal volume, 12 frequents/min breathing rate during the two-lung ventilation (TLV), secondary reduced to 6 ml/kg tidal volume, 16-18 frequents/min breathing rate without PEEP (control group) or with 5 cm H2O cm H2O =0.098 kPa) PEEP (PEEP group) during OLV.Hemodynamics and respiratory mechanical parameters were continuously monitored, lung function before operation and at 72 h after operation was detected. Results Compared to before OLV,arterial oxygen tension (PaO2), arterial oxygen saturation (SpO2), oxygenation index (OI) were decreased and intrapulmonary shunt ratio (Qs/Qt) was increased in control group and PEEP group at 30 min after OLV (P < 0.01 or < 0.05). However,PaO2 and SpO2 and OI were higher and Qs/Qt was lower in PEEP group than that in control group at the same time point (P<0.05). In addition, FEV1%, FVC% and FEV1/FVC were (121.8 ± 25.0% ,(117.2 ± 24.3)% , (87.6 ± 15.7)%before operation and (84.9 ± 21.6)%, (77.2 ± 18.3)% , (70.5 ± 12.5)% at 72 h after operation respectively in control group, (116.9 ±24.5)% , (112.1 ±23.6)% , (85.3 ± 13.8)% before operation and (96.3 ± 20.4)%, (88.1 ± 19.8)% , (78.4 ± 10.2)% at 72 h after operation respectively in PEEP group. Although decreased in control group and PEEP group at 72 h after operation comparing with preoperation (P< 0.01 or < 0.05 ), FEV1%, FVC% and FEV1/FVC were higher in PEEP group than those in control group at 72 h after operation (P<0.05). Conclusion Appropriate PEEP increases arterial oxygenation,reduces Qs/Qt and improves pulmonary function during OLV,reduces the risk of hypoxernia and lung injury induced by OLV during perioperation.