CAJ | 학술논문

【目的】探讨压力控制通气-容量保证（PCV-VG）单肺通气（OLV）模式对老年食管癌根治术患者呼吸力学的影响。【方法】将40例行食管癌根治术的老年患者（ASA Ⅰ～Ⅱ级）分为两组，每组20例。所有患者采取七氟烷吸入维持麻醉，插入双腔气管导管。手术进胸前先行双肺定容通气（VCV ），潮气量（VT ）10 mL/kg ，通气频率（f）12次/分钟；进胸后行OLV。A组采用VCV模式，VT为8 mL/kg ，f为12次/分；B组采用 PCV-VG模式，压力限定设为双肺通气时的气道峰压（Ppeak），VT 为8 mL/kg ，f为12次/分。分别于OLV 前（T1）、OLV 30 min（T2）、OLV 60 min（T3）、和恢复双肺通气（TLV）30 min（T4）4个时点观察患者 VT、分钟通气量（MV）、Ppeak、平均气道压（Pmean）、呼气末二氧化碳分压（PET CO2）和计算肺有效动态顺应性（Cdyn）。【结果】与A组比较，B组Ppeak、Pmean降低，VT 、MV、PET CO2无显著性差异，而Cdyn升高。【结论】老年患者食管癌根治术OLA时采用PCV-VG模式可降低Ppeak ，同时又保证了通气量，改善了Cdyn ，利于老年患者肺保护。
【목적】탐토압력공제통기-용량보증（PCV-VG）단폐통기（OLV）모식대노년식관암근치술환자호흡역학적영향。【방법】장40례행식관암근치술적노년환자（ASA Ⅰ～Ⅱ급）분위량조，매조20례。소유환자채취칠불완흡입유지마취，삽입쌍강기관도관。수술진흉전선행쌍폐정용통기（VCV ），조기량（VT ）10 mL/kg ，통기빈솔（f）12차/분종；진흉후행OLV。A조채용VCV모식，VT위8 mL/kg ，f위12차/분；B조채용 PCV-VG모식，압력한정설위쌍폐통기시적기도봉압（Ppeak），VT 위8 mL/kg ，f위12차/분。분별우OLV 전（T1）、OLV 30 min（T2）、OLV 60 min（T3）、화회복쌍폐통기（TLV）30 min（T4）4개시점관찰환자 VT、분종통기량（MV）、Ppeak、평균기도압（Pmean）、호기말이양화탄분압（PET CO2）화계산폐유효동태순응성（Cdyn）。【결과】여A조비교，B조Ppeak、Pmean강저，VT 、MV、PET CO2무현저성차이，이Cdyn승고。【결론】노년환자식관암근치술OLA시채용PCV-VG모식가강저Ppeak ，동시우보증료통기량，개선료Cdyn ，리우노년환자폐보호。
To explore the effect of one-lung ventilation (OLV ) with pressure control ventilation-volume guarantee(PCV-VG) on respiratory mechanics in elderly patients undergoing radical esophageal cancer sur-gery .[Methods] Totally 40 elderly patients(ASA Ⅰ ~ Ⅱ) undergoing radical esophageal cancer surgery were di-vided into two groups with 20 in each .All patients were given sevoflurane inhalation for maintenance anesthesia and intubated with double lumen endotracheal catheter .Two-lung volume controlled ventilation(VCV) with a tidal volume(VT) of 10ml/kg and frequency(f) of 12 breaths per minute were performed before chest opening .After chest was opened ,OLV was performed .Group A received VCV mode with a VT of 8ml/kg and f of 12 breaths per minute .Group B received PCV-VG mode with the same peak airway pressure (Ppeak) as that during two-lung VCV ,VT of 8ml/kg and f of 12 breaths per minute .The VT ,minute volume(MV) ,Ppeak ,mean airway pres-sure(Pmean) ,end-tidal pressure of carbon dioxide (PET CO2 ) and dynamic lung compliance (Cdyn) before OLA (T1 ) ,30min after OLA(T2 ) ,60min after OLA(T3 ) and 30min after two-lung ventilation(TLA) were observed . Lung effective dynamic compliance(Cdyn) was calculated .[Results]Compared with group A ,Ppeak and Pmean in group B were decreased ,but there was no significant difference in VT ,MV and PET CO2 ,and Cdyn was increased .[Conclusion] PCV-VG mode in OLA for elderly patients undergoing radical esophageal cancer surgery can decrease Ppeak ,ensure ventilatory capacity and improve Cdyn ,so it is good for lung protection in elderly patients .