CAJ | 학술논문

目的评价肺保护性通气策略对食管癌根治术老年患者单肺通气期间脑氧饱和度(rSO2)的影响.方法择期行食管癌根治术的患者40例,年龄65～76岁,体重45～75 kg,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将其随机分为2组(n=20):常规通气组(CV组)和保护性通气组(PV组).静脉注射咪达唑仑0.05 mg/kg、舒芬太尼0.4μg/kg、罗库溴铵1mg/kg和异丙酚1.5mg/kg麻醉诱导,左侧插入左侧双腔支气管导管进行机械通气.CV组双肺通气和单肺通气期间VT均为10 ml/kg,吸呼比均为1:2;PV组双肺通气和单肺通气期间VT均为6 ml/kg,吸呼比均为1:2,并给予PEEP 5cm H2O；两组维持PETCO235-45 mm Hgo吸入2％七氟醚,间断静脉注射罗库溴铵0.5 mg/kg维持麻醉.于麻醉诱导前、双肺通气10 min和单肺通气30 min时,进行动脉血气分析,计算肺内分流率(Qs/Qt),记录rSO7.记录单肺通气期间低rS02(rS02积分＞3000％)的发生情况.结果与CV组比较,PV组单肺通气30 min时PaO2和rSO2升高,Qs/Qt降低,低rS)2发生率降低(P＜0.05).结论肺保护性通气策略可改善食管癌根治术老年患者单肺通气期间的氧合,降低肺内分流,减少低rSO2,的发生.
목적 평개폐보호성통기책략대식관암근치술노년환자단폐통기기간뇌양포화도(rSO2)적영향.방법 택기행식관암근치술적환자40례,년령65～76세,체중45～75 kg,ASA분급Ⅰ～Ⅲ급,채용수궤수자표법,장기수궤분위2조(n=20):상규통기조(CV조)화보호성통기조(PV조).정맥주사미체서륜0.05 mg/kg、서분태니0.4μg/kg、라고추안1mg/kg화이병분1.5mg/kg마취유도,좌측삽입좌측쌍강지기관도관진행궤계통기.CV조쌍폐통기화단폐통기기간VT균위10 ml/kg,흡호비균위1:2;PV조쌍폐통기화단폐통기기간VT균위6 ml/kg,흡호비균위1:2,병급여PEEP 5cm H2O；량조유지PETCO235-45 mm Hgo흡입2％칠불미,간단정맥주사라고추안0.5 mg/kg유지마취.우마취유도전、쌍폐통기10 min화단폐통기30 min시,진행동맥혈기분석,계산폐내분류솔(Qs/Qt),기록rSO7.기록단폐통기기간저rS02(rS02적분＞3000％)적발생정황.결과 여CV조비교,PV조단폐통기30 min시PaO2화rSO2승고,Qs/Qt강저,저rS)2발생솔강저(P＜0.05).결론 폐보호성통기책략가개선식관암근치술노년환자단폐통기기간적양합,강저폐내분류,감소저rSO2,적발생.
Objective To investigate the effect of lung protective ventilation regimen on regional cerebral oxygen saturation(rSO2)during one-lung ventilation(OLV)in elderly patients undergoing radical esophagus cancer resection.Methods Forty ASA Ⅰ-Ⅲ patients,aged 65-76 yr,weighing 45-75 kg,undergoing radical esophagus cancer reseclion,were randomly divided into 2 groups(n =20 each):conventional ventilation group(group CV)and prolective ventilation regimen group(group PV).Anesthesia was induced with midaaolam 0.05 mg/kg,sufentanil 0.4 μg/kg,rocuronium 1 mg/kg and propofol 1.5 mg/kg and maintained with 2％ sevoflurane and intermittenl iv boluses of rocuronium 0.5 mg/kg.Double lumen tube was inserted.Correct positioning was verified by fiberoptic broncboscopy.The patients were mechanically ventilated.In group CV,PEEP was set at 0,Vt was set at 10 ml/kg,and I:E was set at 1:2 during two-lung ventilation(TLV)and OLV.In group PV,PEEP was set at 5 cm H2O,Vt was set at 6 ml/kg,and I:E was set at 1:2 during TLV and OLV.PETCO2 was maintained at 35-40 mn Hg in both groups.Arterial blood samples were taken before induction of anesthesia,at 10 min of TLV and at 30 min of OLV for blood gas analysis.Qs/Qt was calculated and rSO2 was recorded at the same time.Low rSO2 (rSO2 score ＞ 3000％)was recorded during OLV.Results Compared with group CV,PaO2 and rSO2 were significantly increased,and Qs/Qt was significantly decreased at 30 min of OLV,and the incidence of low rSO2 was significanfly decreased in group PV(P ＜ 0.05).Conclusion Lung protective ventilation regimen can improve oxygenation,decrease intrapulmonary shunt,and reduce the occurrence of low rSO2 during OLV in elderly patients undergoing radical esophagus cancer resection.