中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2010年
7期
811-813
,共3页
潮气量%正压呼吸%血管外肺水%呼吸,人工
潮氣量%正壓呼吸%血管外肺水%呼吸,人工
조기량%정압호흡%혈관외폐수%호흡,인공
Tidal volume%Positive-pressure respiration%Extravascular lung water%Respiration,artificial
目的 探讨小潮气量联合呼气末正压(PEEP)对单肺通气时胸外科手术患者血管外肺水的影响.方法 食道癌手术患者40例,年龄45～80岁,体重48～83kg,性别不限,ASA分级Ⅰ或Ⅱ级,随机分为2组(n=20):传统模式单肺通气组(Ⅰ组)机械通气模式为间歇正压通气(IPPV),VT9 ml/kg,通气频率12次/min;小潮气量联合PEEP单肺通气组(Ⅱ组)机械通气模式为IPPV联合PEEP5 cm H2O,VT6 ml/kg,通气频率15次/min.于麻醉诱导前(T0)、双肺通气30 min(T1)、单肺通气30 min(T2)、单肺通气1 h(T3)、恢复双肺通气拔管前(T4)和术后18 h(T5)时,记录血管外肺水(EVLW)、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)和心输出量(CO),于T1～4时记录气道峰压(Ppeak);取股动脉血样,进行血气分析,并计算氧合指数(OI).结果 与Ⅰ组比较,Ⅱ组单肺通气期间EVLWI和.PVPI升高(P＜0.05),其余指标比较差异无统计学意义(P＞0.05);两组各时点OI、CO和Poeak比较差异无统计学意义(P＞0.05);与T0时比较,Ⅰ组T1时PVPI升高(P＜0.05),其余时点PVPI、EVLW和EVLWI差异无统计学意义(P＞0.05),Ⅱ组T2时EVLW、T1～4时EVLWI和T1.2时PVPI升高(P＜0.05);与T1时比较,Ⅰ组T2～5时EVLW、EVLWI和PVPI差异无统计学意义,Ⅱ组T5时PVPI降低(P＜0.05).结论 采用VT6 ml/kg、PEEP 5 cm H2O的单肺通气可增加患者血管外肺水,未对肺功能产生有利作用.
目的 探討小潮氣量聯閤呼氣末正壓(PEEP)對單肺通氣時胸外科手術患者血管外肺水的影響.方法 食道癌手術患者40例,年齡45～80歲,體重48～83kg,性彆不限,ASA分級Ⅰ或Ⅱ級,隨機分為2組(n=20):傳統模式單肺通氣組(Ⅰ組)機械通氣模式為間歇正壓通氣(IPPV),VT9 ml/kg,通氣頻率12次/min;小潮氣量聯閤PEEP單肺通氣組(Ⅱ組)機械通氣模式為IPPV聯閤PEEP5 cm H2O,VT6 ml/kg,通氣頻率15次/min.于痳醉誘導前(T0)、雙肺通氣30 min(T1)、單肺通氣30 min(T2)、單肺通氣1 h(T3)、恢複雙肺通氣拔管前(T4)和術後18 h(T5)時,記錄血管外肺水(EVLW)、血管外肺水指數(EVLWI)、肺血管通透性指數(PVPI)和心輸齣量(CO),于T1～4時記錄氣道峰壓(Ppeak);取股動脈血樣,進行血氣分析,併計算氧閤指數(OI).結果 與Ⅰ組比較,Ⅱ組單肺通氣期間EVLWI和.PVPI升高(P＜0.05),其餘指標比較差異無統計學意義(P＞0.05);兩組各時點OI、CO和Poeak比較差異無統計學意義(P＞0.05);與T0時比較,Ⅰ組T1時PVPI升高(P＜0.05),其餘時點PVPI、EVLW和EVLWI差異無統計學意義(P＞0.05),Ⅱ組T2時EVLW、T1～4時EVLWI和T1.2時PVPI升高(P＜0.05);與T1時比較,Ⅰ組T2～5時EVLW、EVLWI和PVPI差異無統計學意義,Ⅱ組T5時PVPI降低(P＜0.05).結論 採用VT6 ml/kg、PEEP 5 cm H2O的單肺通氣可增加患者血管外肺水,未對肺功能產生有利作用.
목적 탐토소조기량연합호기말정압(PEEP)대단폐통기시흉외과수술환자혈관외폐수적영향.방법 식도암수술환자40례,년령45～80세,체중48～83kg,성별불한,ASA분급Ⅰ혹Ⅱ급,수궤분위2조(n=20):전통모식단폐통기조(Ⅰ조)궤계통기모식위간헐정압통기(IPPV),VT9 ml/kg,통기빈솔12차/min;소조기량연합PEEP단폐통기조(Ⅱ조)궤계통기모식위IPPV연합PEEP5 cm H2O,VT6 ml/kg,통기빈솔15차/min.우마취유도전(T0)、쌍폐통기30 min(T1)、단폐통기30 min(T2)、단폐통기1 h(T3)、회복쌍폐통기발관전(T4)화술후18 h(T5)시,기록혈관외폐수(EVLW)、혈관외폐수지수(EVLWI)、폐혈관통투성지수(PVPI)화심수출량(CO),우T1～4시기록기도봉압(Ppeak);취고동맥혈양,진행혈기분석,병계산양합지수(OI).결과 여Ⅰ조비교,Ⅱ조단폐통기기간EVLWI화.PVPI승고(P＜0.05),기여지표비교차이무통계학의의(P＞0.05);량조각시점OI、CO화Poeak비교차이무통계학의의(P＞0.05);여T0시비교,Ⅰ조T1시PVPI승고(P＜0.05),기여시점PVPI、EVLW화EVLWI차이무통계학의의(P＞0.05),Ⅱ조T2시EVLW、T1～4시EVLWI화T1.2시PVPI승고(P＜0.05);여T1시비교,Ⅰ조T2～5시EVLW、EVLWI화PVPI차이무통계학의의,Ⅱ조T5시PVPI강저(P＜0.05).결론 채용VT6 ml/kg、PEEP 5 cm H2O적단폐통기가증가환자혈관외폐수,미대폐공능산생유리작용.
Objective To investigate the effects of small tidal volume combined with PEEP on extravascular lung water during one-lung ventilation (OLV) in patients undergoing thoracic surgery. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 45-80 yr undergoing esophagectomy for esophageal cancer were randomly assigned into 2 groups (n = 20 each):group Ⅰ IPPV (VT 9 ml/kg ,RR 12 bpm) and group Ⅱ IPPV +PEEP (VT 6 ml/kg, RR 15 bpm, PEEP 5 cm H-2O). FiO2 was 100% and I:E 1:2 in both groups. Anesthesia was induced with fentanyl 3-5 μg/kg, propofol 1.0-1.5 mg/kg and vecuronium 0.10-0.15 mg/kg and maintained with continuous infusion of propofol 4-7 mg· kg- 1 · h - 1 and vecuronium 0.07-0.08 mg- kg- 1 · h - 1 and intermittent iv boluses of fentanyl. Double lumen endobronchial tube was inserted. Correct position was confirmed by bronchoscopy. Right internal jugular vein was cannulated. A 4F thermodilution catheter was inserted into right femoral artery and connected to PICCO monitor. Extravascular lung water (EVLW), EVLW index (EVLWI),pulmonary vascular permeability index (PVPI), cardiac output (CO) and oxygenation index (OI) were recorded before anesthesia (T0, baseline), at 30 min of two lung ventilation (T1), 30 min and 1 h of OLV (T2, T3),before extubation (T4) and 18 h after operation (T5). Airway peak pressure (Ppeak) was recorded at T1-4. Results EVLWI and PVPI were significantly higher in group IPPV + PEEP than in group IPPV. There was no significant difference in Ppeak, CO and OI at any time point between the 2 groups. In group IPPV there was no significant change in EVLW and EVLWI during and after mechanical ventilation, while PVPI was significantly increased at T1 as compared with the baseline before anesthesia. In group IPPV + PEEP EVLW was significantly increased at T2 and PVPI was significantly increased at T1 and T2 compared with the baseline at T0. Conclusion OLV with IPPV + PEEP results in more EVLW and it exerts no significant effect on lung function.
