CAJ | 학술논문

目的评价不同单,肺通气模式对开胸手术患者血流动力学的影响.方法选择拟行肺叶切除术或食道癌根治术的患者45例,年龄45～64岁,采用随机数字表法,将患者随机分为3组(n=15),间歇正压通气组(IPPV组)；IPPV+呼气末正压组(IPPV+PEEP组):IPPV+5 cm H2O PEEP单肺通气30 min后,再行IPPV+10 cm H2O PEEP单肺通气30 min:IPPV+持续气道正压通气组(IPPV+CPAP组)通气侧肺采用IPPV模式,术侧肺加用5 cm H2OCPAP模式1h.于麻醉诱导前、气管插管后10 min、双肺通气30 min、单肺通气30 min、1h及术毕(T1-6)时记录MAP、HR,心排血量(CO)、心指数(CI)、每搏量(SV)和每搏指数(SVI).并于 T1,2,4-6时采集动脉血样行血气分析,记录血糖(Glu)和血乳酸(Lac)水平,计算氧供(DO2)及氧供指数(DO2I).结果与IPPV组比较,IPPV+PEEP组T4,5时SV、SVI、CO、CI、DO2,DO2I降低(P＜0.05),Glu和Lac水平差异无统计学意义,IPPV+CPAP组上述各指标比较差异无统计学意义(P＞0.05).与IPPV+ PEEP组比较,IPPV+ CPAP组T4,5时SV、SVI、CO、CI、DO2、DO2I升高(P＜0.05),Glu和Lac水平差异无统计学意义(P＞0.05).结论开胸手术患者通气侧肺采用IPPV模式,术侧肺加用5 cm H2O CPAP模式对患者血流动力学无明显影响,而通气侧肺IPPV+ PEEP模式虽然可导致血流动力学波动,但程度较小,可维持正常的机体氧供.
목적 평개불동단,폐통기모식대개흉수술환자혈류동역학적영향.방법 선택의행폐협절제술혹식도암근치술적환자45례,년령45～64세,채용수궤수자표법,장환자수궤분위3조(n=15),간헐정압통기조(IPPV조)；IPPV+호기말정압조(IPPV+PEEP조):IPPV+5 cm H2O PEEP단폐통기30 min후,재행IPPV+10 cm H2O PEEP단폐통기30 min:IPPV+지속기도정압통기조(IPPV+CPAP조)통기측폐채용IPPV모식,술측폐가용5 cm H2OCPAP모식1h.우마취유도전、기관삽관후10 min、쌍폐통기30 min、단폐통기30 min、1h급술필(T1-6)시기록MAP、HR,심배혈량(CO)、심지수(CI)、매박량(SV)화매박지수(SVI).병우 T1,2,4-6시채집동맥혈양행혈기분석,기록혈당(Glu)화혈유산(Lac)수평,계산양공(DO2)급양공지수(DO2I).결과 여IPPV조비교,IPPV+PEEP조T4,5시SV、SVI、CO、CI、DO2,DO2I강저(P＜0.05),Glu화Lac수평차이무통계학의의,IPPV+CPAP조상술각지표비교차이무통계학의의(P＞0.05).여IPPV+ PEEP조비교,IPPV+ CPAP조T4,5시SV、SVI、CO、CI、DO2、DO2I승고(P＜0.05),Glu화Lac수평차이무통계학의의(P＞0.05).결론 개흉수술환자통기측폐채용IPPV모식,술측폐가용5 cm H2O CPAP모식대환자혈류동역학무명현영향,이통기측폐IPPV+ PEEP모식수연가도치혈류동역학파동,단정도교소,가유지정상적궤체양공.
Objective To investigate the effects of different modes of one-lung ventilation (OLV) on hemodynamies in the patients undergoing thoracic operation.Methods Forty-five adult patients undergoing thoracic surgery,were randomly allocated into 3 groups based on the modes of OLV used ( n =15 each):intermittent positive pressure ventilation ( IPPV,VT 6-8 ml/kg,RR 10-14 bpm,I:E 1:2) group,IPPV + positive end-expiratory pressure (PEEP) group and IPPV + continuous positive airway pressure (CPAP) group.Double-lumen tube was inserted.Conrrect positioning was verified by fiberoptic bronchoscopy.The patients were mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.In group IPPV + PEEP,OLV was performed for 30 min with PEEP of 5 cm H2O and then for another 30 min with PEEP of 10 cm H2O.In group IPPV + CPAP,OLV was performed with IPPV in the lung on the ventilated side and with CPAP of 5 cm H2O in the lung on the operated side (for 1 h).MAP,HR,cardiac output (CO),cardiac index ( CI),stroke volume (SV),and stnoke volume index (SVI) were recorded before induction of anesthesia,at 10 min after intubation,at 30 min of two-lung ventilation,at 30 min and 1 h of OLV,and at the end of operation ( T1-6 ).Arterial blood samples were taken at T1,2,4-6 for blood gas analysis.The levels of blood glucose and lactate were measured.Oxygen delivery ( DO2 ) and DO2 index ( DO2I) were calculated.Results Compared with IPPV group,SV,SVI,CO,CI,DO2 and DO2I were significantly decreased at T4,5 ( P ＜ 0.05),and no significant change was found in the levels of blood glucose and lactate in group IPPV + PEEP,and no significant change was found in the parameters mentioned above in group IPPV + CPAP ( P ＞ 0.05).Compared with IPPV + PEEP group,SV,SVI,CO,CI,DO2 and DO2I were significantly increased at T4,5 ( P ＜ 0.05),and no significant change was found in the levels of blood glucose and lactate in group IPPV + CPAP ( P ＞ 0.05).Conclusion It exerts no influence on hemodynamics using OLV with IPPV in the lung on the ventilated side and with CPAP of 5 cm H2O in the lung on the operated side,however,OLV with IPPV + PEEP can result in hemodynamic fluctuation,but the degree of fluctuation is lesser and DO2 can be maintained in the patients undergoing thoracic operation.