中国临床实用医学
中國臨床實用醫學
중국림상실용의학
CHINA CLINICAL PRACTICAL MEDICINE
2008年
6期
31-33
,共3页
单肺通气%定容通气%定压通气%胸科手术
單肺通氣%定容通氣%定壓通氣%胸科手術
단폐통기%정용통기%정압통기%흉과수술
One-lung ventilation%Volume controlled ventilation%Pressure eomtrolled ventilation%Thoracic surgery
目的 比较胸科手术单肺通气(OLV)期间采用定容(VCV)和定压(PCV)两种不同通气模式的效果.方法 ASA Ⅰ～Ⅱ级、年龄18～68岁需行单肺通气胸科手术患者24例,随机分为Ⅰ、Ⅱ两组,每组各12例.全身麻醉诱导插双腔管后,侧卧位行双肺定容通气(TLV-VCV)后I组先单肺定容通气(OLV.VCV)30 min后行单肺定压通气(OLV.PCV),II组单肺通气的顺序与Ⅰ组相反,即先定压通气(OLV-PCV)30 min再定容通气(OLV-VCV).双肺定容通气后,每种单肺通气后30 min测定并记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、脉搏氧饱和度(SpO2)、气道峰压(Ppeak)、平均气道压(Pmean)、潮气量(VT)、呼吸末二氧化碳分压(PETCO2).同时抽动血测血氧分压、氧饱和度(PaO2、SaO2)及二氧化碳分压(PaCO2).结果 患者TLV-VCV,OLV-VCV与OLV-PCV期间的HR、MAP、CVP、SpO2差异无统计学意义(P>0.05);OLV-VCV和OLV-PCV的Ppeak和Pmean较TLV-VCV高(P<0.05或P<0.01),而OLV-VCV又比OLV-PCV高(P<0.05或P<0.01);OLV-PCV的PaO2较OLV-VCV高(P<0.01),三种通气的VT、SaO2、PETCO2、PaCO2差异无统计学意义(P>0.05).结论 单肺定压通气效果优于单肺定容通气.
目的 比較胸科手術單肺通氣(OLV)期間採用定容(VCV)和定壓(PCV)兩種不同通氣模式的效果.方法 ASA Ⅰ～Ⅱ級、年齡18～68歲需行單肺通氣胸科手術患者24例,隨機分為Ⅰ、Ⅱ兩組,每組各12例.全身痳醉誘導插雙腔管後,側臥位行雙肺定容通氣(TLV-VCV)後I組先單肺定容通氣(OLV.VCV)30 min後行單肺定壓通氣(OLV.PCV),II組單肺通氣的順序與Ⅰ組相反,即先定壓通氣(OLV-PCV)30 min再定容通氣(OLV-VCV).雙肺定容通氣後,每種單肺通氣後30 min測定併記錄心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP)、脈搏氧飽和度(SpO2)、氣道峰壓(Ppeak)、平均氣道壓(Pmean)、潮氣量(VT)、呼吸末二氧化碳分壓(PETCO2).同時抽動血測血氧分壓、氧飽和度(PaO2、SaO2)及二氧化碳分壓(PaCO2).結果 患者TLV-VCV,OLV-VCV與OLV-PCV期間的HR、MAP、CVP、SpO2差異無統計學意義(P>0.05);OLV-VCV和OLV-PCV的Ppeak和Pmean較TLV-VCV高(P<0.05或P<0.01),而OLV-VCV又比OLV-PCV高(P<0.05或P<0.01);OLV-PCV的PaO2較OLV-VCV高(P<0.01),三種通氣的VT、SaO2、PETCO2、PaCO2差異無統計學意義(P>0.05).結論 單肺定壓通氣效果優于單肺定容通氣.
목적 비교흉과수술단폐통기(OLV)기간채용정용(VCV)화정압(PCV)량충불동통기모식적효과.방법 ASA Ⅰ～Ⅱ급、년령18～68세수행단폐통기흉과수술환자24례,수궤분위Ⅰ、Ⅱ량조,매조각12례.전신마취유도삽쌍강관후,측와위행쌍폐정용통기(TLV-VCV)후I조선단폐정용통기(OLV.VCV)30 min후행단폐정압통기(OLV.PCV),II조단폐통기적순서여Ⅰ조상반,즉선정압통기(OLV-PCV)30 min재정용통기(OLV-VCV).쌍폐정용통기후,매충단폐통기후30 min측정병기록심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP)、맥박양포화도(SpO2)、기도봉압(Ppeak)、평균기도압(Pmean)、조기량(VT)、호흡말이양화탄분압(PETCO2).동시추동혈측혈양분압、양포화도(PaO2、SaO2)급이양화탄분압(PaCO2).결과 환자TLV-VCV,OLV-VCV여OLV-PCV기간적HR、MAP、CVP、SpO2차이무통계학의의(P>0.05);OLV-VCV화OLV-PCV적Ppeak화Pmean교TLV-VCV고(P<0.05혹P<0.01),이OLV-VCV우비OLV-PCV고(P<0.05혹P<0.01);OLV-PCV적PaO2교OLV-VCV고(P<0.01),삼충통기적VT、SaO2、PETCO2、PaCO2차이무통계학의의(P>0.05).결론 단폐정압통기효과우우단폐정용통기.
Objective To compare the effects of volume controlled with pressure comtrolled one-lung ventilation during thoracic surgery. Methods Twenty-four ASA Ⅰ～Ⅱ patients ( 18 male ,6 female)aged 18～68 years old undergoing one-lung ventilation (OLV) thoracic surgery were randomly divided into 2 groups ( n = 12 cases). After general anesthesia induction was performed, each patient was inserted a double-lumen tube. Twolung ventilated with volume controlled ventilation (TLV-VCV) was carried out in the lateral decubitus position in all patients. In group Ⅰ, one-lung ventilation was started by volume controlled ventilation (OLV-VCV) for 30 minutes and ventilation mode was then swithched to pressure controlled ventilation (OLV-PCV). Ventilation modes were performed in the opposite order in group Ⅱ, one-lung ventilation was started by pressure controlled ventilation (OLV-PCV) for 30 minutes and ventilation mode was then swithched to volume controlled ventilation (OLV-VCV). The following variables were measured and recorded at the end of TLV-VCV and at 30 minutes of OLV-VCV or OLV-PCV. Heart rate (HR),mean arterial pressure (MAP) and pulse oxygen degree (SpO2) were measured by a same HP monitor. Central venous pressure (CVP) was measured by a special ruler. Tidal volume (VT), peak airway pressure (Ppeak) and mean airway pressure (Pmean) were measured by a same Datex-Ohmeda Aestiva/5 anesthesia machine. End-tide carbon dioxide pressure was measured by a monitor of anesthesia machine. Meantime arterial blood oxygen tsensions and saturations (PaO2, Sat2) and arterial blood carbon dioxide tsensions (PaCO2) were analysed by arterial venous blood gases. Results There were no significant differences in HR, MAP, CVP and SpO2 between TLV-VCV, OLV-VCV and OLV-VCV (P>0. 05). Ppeak and Pmean were significant higher during OLV-VCV or OLV-PCV than during TLV-VCV (P < 0.05 or P < 0. 01) ,but these were higher during OLV-VCV than during OLV-PCV (P <0. 05 or P <0. 01). PaO2 was higher during OLV-PCV than during OLV-VCV (P < 0. 05). There were no significant difference in VT, SaO2, PET CO2, PaCO2 between OLV-VCV and OLV-PCV (P>0.05). Conclusion The effects of OLV-PCV was superior to OLV-VCV during thoracic surgery.
