CAJ | 학술논문

目的评价选择性肺叶隔离通气用于慢性阻塞性肺病(COPD)老年患者开胸手术时的通气效果.方法择期拟行食管癌根治术合并COPD的老年患者30例,年龄65～80岁,体重指数16～ 28 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为2组(n=15):单肺通气组(OLV组)和选择性肺叶隔离通气组(SLC组).OLV组患者采用双腔气管导管实施单肺通气,SLC组患者使用支气管堵塞器堵塞肺叶支气管,实施选择性肺叶隔离通气.于平卧位双肺通气10 min(T0)、侧卧位单肺通气或选择性肺叶隔离通气5 min(T1)、45 min(T2)、90 min(T3)、术毕侧卧位双肺通气10 min(T4)时测定气道峰压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)和动态肺顺应性(Cd).于T0、T3、T4时采集动脉血样,行血气分析,计算氧合指数(OI)、肺泡-动脉血氧分压差[P(A-a)Q2]和呼吸指数(RI).结果与OLV组比较,SLC组T2～4时Peak、Pplat及Raw降低,T1～4时Cd升高,T3,4时0I升高、P(A-a)O2和RI降低(P＜ 0.05或0.01).结论 COPD老年患者胸科手术时,单肺通气和选择性肺叶隔离通气均可安全完成手术,实施肺叶隔离通气能改善氧合,具有更好的通气效果.
목적 평개선택성폐협격리통기용우만성조새성폐병(COPD)노년환자개흉수술시적통기효과.방법 택기의행식관암근치술합병COPD적노년환자30례,년령65～80세,체중지수16～ 28 kg/m2,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법,장기수궤분위2조(n=15):단폐통기조(OLV조)화선택성폐협격리통기조(SLC조).OLV조환자채용쌍강기관도관실시단폐통기,SLC조환자사용지기관도새기도새폐협지기관,실시선택성폐협격리통기.우평와위쌍폐통기10 min(T0)、측와위단폐통기혹선택성폐협격리통기5 min(T1)、45 min(T2)、90 min(T3)、술필측와위쌍폐통기10 min(T4)시측정기도봉압(Ppeak)、기도평태압(Pplat)、기도조력(Raw)화동태폐순응성(Cd).우T0、T3、T4시채집동맥혈양,행혈기분석,계산양합지수(OI)、폐포-동맥혈양분압차[P(A-a)Q2]화호흡지수(RI).결과 여OLV조비교,SLC조T2～4시Peak、Pplat급Raw강저,T1～4시Cd승고,T3,4시0I승고、P(A-a)O2화RI강저(P＜ 0.05혹0.01).결론 COPD노년환자흉과수술시,단폐통기화선택성폐협격리통기균가안전완성수술,실시폐협격리통기능개선양합,구유경호적통기효과.
Objective To investigate the efficacy of ventilation with selective lobar collapse for thoracic surgery in elderly patients with chronic obstructive pulmonary disease (COPD).Methods Thirty ASA Ⅱ or Ⅲ patients with COPD,aged 65-80 yr,with a body mass index of 16-28 kg/m2,undergoing radical resection of esophagus cancer,were randomly divided into 2 groups (n=15 each):one-lung ventilation (OLV) group and ventilation with selective lobar collapse group (group SLC).In group OLV,OLV was performed,while in group SLC,the balloon of the blocker was placed at 0.5 cm below the opening of the upper lobe bronchus and the lower lobe was collapsed when chest was open.The patients were mechanically ventilated (VT =7-8 ml/kg,RR =14-16 bpm,I∶E=1∶1.5-2.0,FiO2 =100％).Peak pressure (Ppeak),plateau pressure (Pplat),airway resistance (Raw),and dynamic lung compliance (Cd) were measured at 10 min of two-lung ventilation in supine position (T0),at 5,45 and 90 min of OLV or selective lobar collapse (T1-3) and at 10 min of two-lung ventilation in lateral position after the end of operation (T4).Arterial blood samples were obtained at To,T3 and T4 for blood gas analysis.Oxygenation index (OI),alveolar-arterial oxygen gradiant (P(A-a)O2),and respiratory index (RI) were calculated.Results Ppeak,Pplat and Raw were significantly lower at T2-4,while Cd was significantly greater at T1-4,OI was significantly higher at T3,4,and P(A-a)O2 and RI were significantly lower at T3,4 in group SLC than in group OLV.Conclusion The thoracic operation can be completed safely using ventilation with selective lobar collapse and OLV,however,ventilation with selective lobar collapse can improve oxygenation and provides better ventilatory efficacy than OLV in elderly patients with COPD.