CAJ | 학술논문

目的探讨单肺通气时应用不同水平的呼气末正压(PEEP)对胸腔镜肺大疱切除术患者术中血气分析及血流动力学的影响.方法将78例行胸腔镜肺大疱切除术患者按随机数字表法分为三组,每组26例:Ⅰ组双肺通气后仅给予单肺间歇正压通气(IPPV),Ⅱ组双肺通气后给予单肺IPPV加PEEP5 cmH2O(1 cmH2O=0.098 kPa),Ⅲ组双肺通气后给予单肺IPPV加PEEP 10 cmH2O.记录并比较三组平卧位双肺通气、侧卧位双肺通气、单肺通气10和30 min的血气分析和血流动力学.结果三组患者脉搏血氧饱和度均维持在0.99～ 1.00.三组各时间点pH值、剩余碱、动脉血二氧化碳分压(PaCO2)、HCO3-比较差异均无统计学意义(P＞0.05).Ⅱ、Ⅲ组单肺通气10,30 min动脉血氧分压(PaO2)明显高于Ⅰ组[(336.2±113.2),(348.5±109.7) mmHg(1mmHg=0.133 kPa)比(285.0±103.5) mmHg,(357.6±104.0),(358.9±103.2) mmHg比(276.0±107.2) mmHg],差异有统计学意义(P＜0.05),但均在正常范围内,Ⅱ组和Ⅲ组比较差异无统计学意义(P＞0.05).三组各时间点心率、平均动脉压、左心室射血时间、体循环血管阻力比较差异均无统计学意义(P＞0.05).Ⅱ组和Ⅲ组单肺通气10,30 min每搏输出量、心输出量明显低于本组平卧位双肺通气、侧卧位双肺通气及Ⅰ组同期,差异均有统计学意义(P＜0.05),但均在正常范围内,Ⅱ组和Ⅲ组比较差异无统计学意义(P＞0.05).结论双肺通气后给予单肺IPPV加PEEP 5 cmH2O在胸腔镜肺大疱切除术中能维持满意的PaO2和PaCO2,血流动力学变化不明显；但PEEP 5 cmH2O较仅IPPV能进一步提高PaO2,而PEEP 10 cmH2O却没有进一步提高PaO2.
목적 탐토단폐통기시응용불동수평적호기말정압(PEEP)대흉강경폐대포절제술환자술중혈기분석급혈류동역학적영향.방법 장78례행흉강경폐대포절제술환자안수궤수자표법분위삼조,매조26례:Ⅰ조쌍폐통기후부급여단폐간헐정압통기(IPPV),Ⅱ조쌍폐통기후급여단폐IPPV가PEEP5 cmH2O(1 cmH2O=0.098 kPa),Ⅲ조쌍폐통기후급여단폐IPPV가PEEP 10 cmH2O.기록병비교삼조평와위쌍폐통기、측와위쌍폐통기、단폐통기10화30 min적혈기분석화혈류동역학.결과 삼조환자맥박혈양포화도균유지재0.99～ 1.00.삼조각시간점pH치、잉여감、동맥혈이양화탄분압(PaCO2)、HCO3-비교차이균무통계학의의(P＞0.05).Ⅱ、Ⅲ조단폐통기10,30 min동맥혈양분압(PaO2)명현고우Ⅰ조[(336.2±113.2),(348.5±109.7) mmHg(1mmHg=0.133 kPa)비(285.0±103.5) mmHg,(357.6±104.0),(358.9±103.2) mmHg비(276.0±107.2) mmHg],차이유통계학의의(P＜0.05),단균재정상범위내,Ⅱ조화Ⅲ조비교차이무통계학의의(P＞0.05).삼조각시간점심솔、평균동맥압、좌심실사혈시간、체순배혈관조력비교차이균무통계학의의(P＞0.05).Ⅱ조화Ⅲ조단폐통기10,30 min매박수출량、심수출량명현저우본조평와위쌍폐통기、측와위쌍폐통기급Ⅰ조동기,차이균유통계학의의(P＜0.05),단균재정상범위내,Ⅱ조화Ⅲ조비교차이무통계학의의(P＞0.05).결론 쌍폐통기후급여단폐IPPV가PEEP 5 cmH2O재흉강경폐대포절제술중능유지만의적PaO2화PaCO2,혈류동역학변화불명현；단PEEP 5 cmH2O교부IPPV능진일보제고PaO2,이PEEP 10 cmH2O각몰유진일보제고PaO2.
Objective To investigate the effect of different levels of positive pressure (PEEP) during one-lung ventilation on blood gas and hemodynamics in patients with thoracoscopic lung bullae resection surgery.Methods Seventy-eight patients undergoing thoracoscopic lung bullae resection surgery were divided into three groups by random number table method,26 cases in each:group Ⅰ was only given one-lung intermittent positive pressure ventilation (IPPV) after two-lung ventilation,group Ⅱ was given one-lung IPPV and PEEP 5 cmH2O (1 cmH2O =0.098 kPa) after two-lung ventilation,group Ⅲ was given one-lung IPPV and PEEP 10 cmH2O after two-lung ventilation.Blood gas and hemodynamics were recorded and compared in the supine position and lateral position two-lung ventilation,one lung ventilation 10 and 30 min among three groups.Results Oxygen saturation was maintained at 0.99-1.00 in three groups.pH value,base excess,arterial carbondioxide partial pressure (PaCO2) and HCO3-at each time point in three groups had no statistical significance (P ＞ 0.05).Arterial oxygen partial pressure (PaO2) in group Ⅱ and group Ⅲ at one-lung ventilation 10,30 min was significantly higher than that in group Ⅰ [(336.2 ± 113.2),(348.5 ± 109.7) mmHg (1 mmHg =0.133 kPa) vs.(285.0 ± 103.5) mmHg,(357.6 ± 104.0),(358.9 ±103.2) mmHg vs.(276.0 ± 107.2) mmHg] (P ＜0.05),but were within the normal range,there was no statistical difference between group Ⅱ and group Ⅲ (p ＞ 0.05).Heart rate,mean arterial pressure,left ventricular ejection time,systemic vascular resistance at each time point in three groups had no statistical significance (P ＞0.05).Stroke volume,cardiac output in group Ⅱ and group Ⅲ at one-lung ventilation 10,30 min were lower than those in supine position and lateral position two-lung ventilation and the same period in group Ⅰ (P ＜ 0.05),but were within the normal range,there were no statistical differences between group Ⅱ and group Ⅲ (p ＞ 0.05).Conclusions Two-lung ventilation after one-lung IPPV and PEEP 5 cmH2O in thoracoscopic lung bullae resection surgery can maintain satisfactory PaO2 and PaCO2,hemodynamic change is not obvious; PEEP 5 cmH2O compares with only IPPV can further improve PaO2,but PEEP 10 cmH20 can't further improve PaO2.