中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2015年
3期
283-286
,共4页
呼吸,人工%食管肿瘤%食管切除术
呼吸,人工%食管腫瘤%食管切除術
호흡,인공%식관종류%식관절제술
Respiration,artificial%Esophageal neoplasms%Esophagectomy
目的 评价肺保护性通气对食管癌根治术病人的肺保护效应.方法 择期全麻下行食管癌根治术病人68例,性别不限,年龄40 ～ 64岁,ASA分级Ⅰ或Ⅱ级,体重指数17～40 kg/m2,采用随机数字表法分为2组(n=34):常规通气组(CV组)和保护性通气组(PV组).麻醉诱导后置入左侧双腔支气管导管,接麻醉机行机械通气.CV组双肺通气时VT10 ml/kg,单肺通气时VT7 ml/kg,吸呼比1∶2;PV组双肺通气时VT7 ml/kg,单肺通气时VT5 ml/kg,吸呼比1∶2,并给予PEEP 10 cmH2O,每45 min双肺行肺复张1次.分别于麻醉诱导前、术后第1天、第3天和第5天时行动脉血气分析,并记录临床改良肺部感染评分;分别于麻醉诱导前和术后第5天时行床旁肺功能检查,记录每分钟最大通气量占预计值的百分比(MVV％)、用力肺活量占预计值的百分比(FVC％)、第1秒用力呼气量占预计值的百分比(FEV1％),计算FEV1/FVC;记录术后5d内呼吸衰竭、肺不张、切口感染等的发生情况.结果 与CV组比较,PV组MVV％、FVC％、FEV1％和FEV1/FVC升高,术后各时点临床改良肺部感染评分降低,SaO2和PaO2升高(P＜0.05),肺不张和切口感染的发生率差异无统计学意义(P＞0.05).结论 肺保护性通气对食管癌根治术病人具有肺保护效应.
目的 評價肺保護性通氣對食管癌根治術病人的肺保護效應.方法 擇期全痳下行食管癌根治術病人68例,性彆不限,年齡40 ～ 64歲,ASA分級Ⅰ或Ⅱ級,體重指數17～40 kg/m2,採用隨機數字錶法分為2組(n=34):常規通氣組(CV組)和保護性通氣組(PV組).痳醉誘導後置入左側雙腔支氣管導管,接痳醉機行機械通氣.CV組雙肺通氣時VT10 ml/kg,單肺通氣時VT7 ml/kg,吸呼比1∶2;PV組雙肺通氣時VT7 ml/kg,單肺通氣時VT5 ml/kg,吸呼比1∶2,併給予PEEP 10 cmH2O,每45 min雙肺行肺複張1次.分彆于痳醉誘導前、術後第1天、第3天和第5天時行動脈血氣分析,併記錄臨床改良肺部感染評分;分彆于痳醉誘導前和術後第5天時行床徬肺功能檢查,記錄每分鐘最大通氣量佔預計值的百分比(MVV％)、用力肺活量佔預計值的百分比(FVC％)、第1秒用力呼氣量佔預計值的百分比(FEV1％),計算FEV1/FVC;記錄術後5d內呼吸衰竭、肺不張、切口感染等的髮生情況.結果 與CV組比較,PV組MVV％、FVC％、FEV1％和FEV1/FVC升高,術後各時點臨床改良肺部感染評分降低,SaO2和PaO2升高(P＜0.05),肺不張和切口感染的髮生率差異無統計學意義(P＞0.05).結論 肺保護性通氣對食管癌根治術病人具有肺保護效應.
목적 평개폐보호성통기대식관암근치술병인적폐보호효응.방법 택기전마하행식관암근치술병인68례,성별불한,년령40 ～ 64세,ASA분급Ⅰ혹Ⅱ급,체중지수17～40 kg/m2,채용수궤수자표법분위2조(n=34):상규통기조(CV조)화보호성통기조(PV조).마취유도후치입좌측쌍강지기관도관,접마취궤행궤계통기.CV조쌍폐통기시VT10 ml/kg,단폐통기시VT7 ml/kg,흡호비1∶2;PV조쌍폐통기시VT7 ml/kg,단폐통기시VT5 ml/kg,흡호비1∶2,병급여PEEP 10 cmH2O,매45 min쌍폐행폐복장1차.분별우마취유도전、술후제1천、제3천화제5천시행동맥혈기분석,병기록림상개량폐부감염평분;분별우마취유도전화술후제5천시행상방폐공능검사,기록매분종최대통기량점예계치적백분비(MVV％)、용력폐활량점예계치적백분비(FVC％)、제1초용력호기량점예계치적백분비(FEV1％),계산FEV1/FVC;기록술후5d내호흡쇠갈、폐불장、절구감염등적발생정황.결과 여CV조비교,PV조MVV％、FVC％、FEV1％화FEV1/FVC승고,술후각시점림상개량폐부감염평분강저,SaO2화PaO2승고(P＜0.05),폐불장화절구감염적발생솔차이무통계학의의(P＞0.05).결론 폐보호성통기대식관암근치술병인구유폐보호효응.
Objective To evaluate the protective effects of lung protective ventilation on the lungs in patients undergoing radical resection for esophageal cancer.Methods Sixty-eight patients of both sexes,aged 40-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index 17-40 kg/m2,scheduled for elective radical resection for esophageal cancer,were randomly divided into conventional ventilation group (CV group,n =34) and protective ventilation group (PV group,n =34) using a random number table.Double lumen tube was inserted after induction of anesthesia,an anesthesia machine was connected,and the patients were mechanically ventilated.In group CV,VT was set at 10 ml/kg during two-lung ventilation,and VT was set at 7 ml/kg,and I ∶ E was set at 1 ∶ 2 during one-lung ventilation.In group PV,VT was set at 7 ml/kg during two-lung ventilation,VT was set at 5 ml/kg,I ∶ E was set at 1 ∶ 2,and PEEP was set at 10 cmH2O during one-lung ventilation,and bilateral lung recruitment maneuver was performed every 45 min.Before induction of anesthesia,and at days 1,3,and 5 after surgery,blood gas analysis was performed,and Clinical Pulmonary Infection Score was recorded.Before induction of anesthesia,and at 5 days after surgery,point-of-care testing for pulmonary function was performed,and percentages of maximum ventilatory volume (MVV％),forced vital capacity (FVC％),and forced expiratory volume in 1 second (FEV1％) were recorded,and FEV1/FVC was calculated.The development of respiratory failure,pulmonary atelectasis and incision infection was recorded within 5 min after surgery.Results Compared with group CV,MVV％,FVC％,FEV1％ and FEV1/FVC were significantly increased,Clinical Pulmonary Infection Score was decreased at each time point after surgery,SaO2 and PaO2 were increased,and no significant changes were found in pulmonary atelectasis and incision infection in group PV.Conclusion Lung protective ventilation can effectively protect the lungs in the patients undergoing radical resection for esophageal cancer.
