单肺通气时不同潮气量对呼吸功能的影响

目的 研究单肺通气(OLV)时不同潮气量时的综合评价.方法 60例右侧开胸左侧卧位非右肺全肺切除患者,ASA Ⅰ或Ⅱ级,随机分为A、B、C三组,每组20例.全麻后双肺通气(TLV)潮气量(VT)均为10 ml/kg,RR为12次/分,吸呼比(I∶E)为1∶2.OLV期间A组VT6ml/kg,B组VT 8 ml/kg,C组VT10 ml/kg,分别于OLV前(T1)及OLV后10 min(T2)、20 min(T3)、30 min(T4)采集动脉血及中心静脉血行实验室检查,并计算肺内分流量(Qs/Qt),同时监测气道压力并计算动态肺顺应性(Cdyn),监测PETCO2,并在T4时对三组患者进行综合评价.结果 与T1时比较,T2～T4时三组PaO2、Cdyn降低,PaCO2、Qs/Qt、Pmax、Pmean明显升高(P＜0.05).与B组比较,T2～T4时C组PaO2降低,Pmax、Pmean明显升高(P＜0.05).T4时B组综合评价最好.结论 OLV期间采用B组VT8 ml/kg相对较好.

General evaluation of difference tidal volume during one lung ventilation

Objective To evaluate difference tidal volume during one lung ventilation(OLV).Methods Sixty ASA Ⅰ or Ⅱ grade patients, scheduled for selective right thoracotomy under left lateral decubitus position were randomly divided into three groups with 20 each: A, B and C. After induction of anesthesia, two lung ventilation(TLV) was performed with VT 10 ml/kg. Respiratory rate (RR) was 12 times per minute (BPM)and ratio of inspiratory to expiratory (I∶E) was 1∶2. During OLV I∶E was keep steady, VT was reduced to 6 ml/kg in group A, 8 ml/kg in group B, and 10m/kg in group C. Laboratory examination was determined before OLV(T1) and 10 min(T2), 20 min(T3), 30 min(T4) after OLV. Qs/Qt and lung compliance (Cdyn) were calculated.Results Three group PaO2 and Cdyn decreased and PaCO2, Qs/Qt,Pmax, and Pmean increased from T2 to T4 when compared with T1. PaO2 deceased and Pmax, Pmean increased from T2 to T4 in group C when compared with group B. Group B had a good general evaluation in T4.Conclusion 8 ml/kg may be a good tidal volume during OLV.