文章摘要
宋田皓,王丽君,李彭依,李甜甜,辜晓岚,顾连兵.不同水平呼气末正压通气联合60%吸入氧浓度对单肺通气患者氧合及术后肺部并发症的影响[J].南京医科大学学报,2021,(4):528~533
不同水平呼气末正压通气联合60%吸入氧浓度对单肺通气患者氧合及术后肺部并发症的影响
The combined physiologic effects of using different positive end⁃expiratory pressure and inspired oxygen fraction of 0.6 during one lung ventilation
投稿时间:2020-08-18  
DOI:10.7655/NYDXBNS20210409
中文关键词: 单肺通气  吸入氧浓度  呼气末正压  氧合  术后肺部并发症
英文关键词: positive end⁃expiratory pressure  one⁃lung ventilation  inspired oxygen fraction  oxygenation  postoperative pulmonary complication
基金项目:江苏省卫生健康委员会科研基金(BJ16028);江苏省肿瘤医院院内基金(ZN201607)
作者单位
宋田皓 徐州医科大学江苏省麻醉学重点实验室江苏省麻醉与镇痛应用技术重点实验室江苏 徐州 221002 
王丽君 江苏省肿瘤医院江苏省肿瘤防治研究所南京医科大学附属肿瘤医院麻醉科江苏 南京 210009 
李彭依 江苏省肿瘤医院江苏省肿瘤防治研究所南京医科大学附属肿瘤医院麻醉科江苏 南京 210009 
李甜甜 徐州医科大学江苏省麻醉学重点实验室江苏省麻醉与镇痛应用技术重点实验室江苏 徐州 221002 
辜晓岚 江苏省肿瘤医院江苏省肿瘤防治研究所南京医科大学附属肿瘤医院麻醉科江苏 南京 210009 
顾连兵 徐州医科大学江苏省麻醉学重点实验室江苏省麻醉与镇痛应用技术重点实验室江苏 徐州 221002江苏省肿瘤医院江苏省肿瘤防治研究所南京医科大学附属肿瘤医院麻醉科江苏 南京 210009 
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中文摘要:
      目的:探讨单肺通气(one?lung ventilation,OLV)期间不同水平呼气末正压(positive end?expiratory pressure,PEEP)联合60%吸入氧浓度(inspired oxygen fraction,FiO2)对OLV患者氧合及术后肺部并发症(postoperative pulmonary complication,PPC)的影响。方法:择期行经左胸食管癌根治术患者120例,随机分为A、B、C、D 4组,每组30例,OLV时各组均使用60%的FiO2,通气侧分别采用0、5、8、10 cmH2O PEEP。于OLV前即刻(T1)、OLV 10 min(T2)、OLV 15 min(T3)、OLV 30 min(T4)、OLV 60 min(T5)、OLV 120 min(T6)时分别经桡动脉与右颈内静脉中抽取动静脉血行血气分析,计算肺内分流率;记录各时间点的血流动力学与呼吸力学等指标;记录术后第2天的临床肺部感染评分(clinical pulmonary infection score,CPIS)和PPC的发生情况。结果:A组2例患者OLV中发生低氧血症而退出本研究,共118例患者完成试验。T2~T6时D组动脉血氧分压(PaO2)明显高于A组、肺内分流率明显低于A组(P < 0.05);T3~T4时C组PaO2明显高于A组、肺内分流率明显低于A组(P < 0.05)。T4时B组PaO2明显高于A组、肺内分流率明显低于A组(P < 0.05)。T2~T5时D组PaO2明显高于B组(P < 0.05);T2~T4时D组肺内分流率明显低于B组(P < 0.05)。T5时D组PaO2明显高于C组(P < 0.05)。T2~T6时B、C、D组驱动压明显低于A组(P < 0.05),T2~T5时C、D组驱动压明显低于B组(P < 0.05)。T4~T6时C、D组肺动态顺应性(dynamic compliance,Cdyn)明显高于A、B组(P < 0.05)。术后第2天B、C、D组CPIS明显低于A组。结论:OLV时FiO2为60%条件下,联合5、8和10 cmH2O PEEP均可改善氧合、降低肺内分流、增加肺动态顺应性,降低驱动压及CPIS,从而具有一定的肺保护作用,其中10 cmH2O PEEP改善氧合的效应出现得更早,效果更佳。
英文摘要:
      Objective:To investigate the combined physiologic effects of different positive end?expiratory pressure(PEEP)and decreased inspired oxygen fraction(FiO2)during one lung ventilation(OLV). Methods:This study is a prospective,single?blind,randomized controlled study. One?hundred and twenty patients were equally randomized into four groups of A(OLV with 0 cmH2O),B(OLV with 5 cmH2O),C(OLV with 8 cmH2O),and D(OLV with 10 cmH2O). All patients breathed an inspiratory oxygen fraction of 0.6. Arterial blood and venous blood were taken for gas analysism,and intrapulmonary shunt rate(Qs/Qt)were calculated before OLV(T1),OLV 10 min(T2),OLV 15 min(T3),OLV 30 min(T4),OLV 60 min(T5),and OLV 120 min(T6). Haemodynamics and respiratory mechanics parameters were monitored continuously. The clinical pulmonary infection score(CPIS)was recorded on the second day after the surgery and the incidence of postoperative pulmonary complication was recorded. Results:Among the 120 patients assessed for eligibility,118 completed the study. At T2~T6,PaO2 in group D was significantly higher than that in group A,Qs/Qt in group D was significantly lower than that in group A(P < 0.05). At T3~T4,PaO2 in group C was significantly higher than that in group A,Qs/Qt in group C was significantly lower than that in group A(P < 0.05). At T4,PaO2 in group B were significantly higher than that in group A,Qs/Qt in group B were significantly lower than that in group A(P < 0.05). At T2~T5,PaO2 in group D were significantly higher than that in group B,At T2 ~ T4,Qs/Qt in group D were significantly lower than that in group B(P < 0.05). At T5,PaO2 in group D were significantly higher than that in group C(P < 0.05). At T2~T6,driving pressure(DP)in group B,C,and D were significantly lower than that in group A(P < 0.05). At T2~T5,DP in group C and D were significantly lower than that in group B(P < 0.05). At T4~T6,dynamic compliances in group C and D were significantly higher than those in group A and B(P < 0.05). The CPIS score was significantly lower in group B,C and D than that in group A on the second day after the surgery(P < 0.05). Conclusion:During one lung ventilation with 0.6 FiO2,10 cmH2O PEEP improves pulmonary function without changing the hemodynamic parameters and reduces driving pressure,and plays an important role in lung protection.
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