胸腔镜手术单肺通气期间非通气侧肺不同处理方法对动脉血氧合肺内分流的影响

目的观察胸腔镜手术单肺通气期间非通气侧肺不同处理方法对动脉血氧合肺内分流的影响。方法将30例择期行胸腔镜手术的病人按单肺通气期间非通气侧肺不同处理方法分为三组:A组将非通气侧肺的支气管导管旷置于大气中,使肺自行萎陷;B组将非通气侧肺的支气管导管内置入一通过湿化装置与氧流量表相连的细导管,氧流量为1 L/min;C组将非通气侧肺的支气管导管出口处接上一负压吸引管,调节适宜压力使肺完全萎陷。在单肺通气前、通气后30和60 min分别采动脉血作血气分析并计算QS/Qt值。结果PaO2在OLV 60 min时A组下降明显,B和C组与A组相比差异有显著性(P<0.05);QS/Qt在OLV 30 min时B和C组与A组相比差异有显著性(P <0.05), OLV 60 min时B和C组与A组相比差异有极显著性(P<0.01),B组与C组间在OLV 30和60 min PaO2,QS/Qt差异均无显著性(P >0.05)。结论B组与C组的非通气侧肺处理方法都能降低肺内分流,提高动脉血氧合,但C组的方法更方便胸腔镜手术中的操作。

Effects of non-ventilated lung treated with different methods on arterial oxygenation and intrapulmonary shunt during one-lung ventilation in thoracoscopic surgery

Objective: To compare effects on arterial oxygenation and intrapulmonary shunt during one-lung ventiation (OLV) when non-ventilated lung was treated with different methods in thoracoscopic surgery. Methods: Thirty ASAI-II patients undergoing thoracoscopic surgery were randomly divided into three groups: Group A: the non-ventilated lung was kept open to the air. Group B: 1 L/min oxygen was insufflated into non-ventilated lung during OLV; Group C: export of non-ventilated lung was connected a conductor with negative-pressure attracter, regulatig appropriate pressure to make lung shrivel completely. Results: PaO2 after OLV 60 min in group A was decreased significantly compared to that in group B and group C (P <0.05). QS/Qt after OLV 30, 60 min in group A was increased significantly compared to that in group B and group C (P <0.05). PaO2 and QS/Qt after OLV 30, 60 min had no significant difference between group B and group C. Conclusion: The methods of group B and group C of non-ventilated lung treated can all decrease intrapulmonary shunt and improve arterial oxygenation. And the method of group C is more convenient for operater to operate in thoracoscopic surgery.