甲基强的松龙对肺叶切除术患者单肺通气时肺功能和炎症反应的影响

目的探讨甲基强的松龙(甲强龙)对肺叶切除术患者单肺通气时肺功能和炎症反应的影响。方法选择择期拟行肺叶切除术患者60例,男46例,女14例,年龄18~60岁,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:甲强龙组(M组)和对照组(C组),每组30例。M组于麻醉诱导前30min静脉注射甲强龙2mg/kg,C组于相同时点静脉注射等量生理盐水。分别记录单肺通气前(T_0)、单肺通气30min(T_1)、单肺通气1h(T_2)、恢复双肺通气10min(T_3)及术毕(T_4)时的MAP、气道峰压(Ppeak)、气道平台压(Pplat)及动态肺顺应性(Cdyn),并于上述时间点抽取桡动脉血行血气分析,检测PaO_2和PaCO_2,计算氧合指数(OI)、肺泡-动脉血氧分压差(A-aDO_2)及呼吸指数(RI)。分别于T_0、T_4、术后6h(T_5)及术后24h(T_6)采集中心静脉血样,采用ELISA法检测血清TNF-α、IL-6及IL-10的浓度。记录术后72h肺部并发症的发生情况。结果与T_0时比较,T_1、T_2时两组MAP、Cdyn明显降低,Ppeak、Pplat明显升高(P0.05);T_1~T_4时OI明显降低,A-aO_2、RI明显升高(P0.05);T_4~T_6时血清TNF-α、IL-6及IL-10浓度明显升高(P0.05)。与C组比较,T_1、T_2时M组Ppeak、Pplat明显降低,Cdyn明显升高(P0.05);T_4~T_6时M组血清TNF-α、IL-6浓度明显降低,IL-10浓度明显升高(P0.05)。两组患者术后72h肺部并发症发生率差异无统计学意义。结论甲强龙可有效改善肺叶切除术患者单肺通气时动态肺顺应性,优化呼吸动力学,减轻机体炎症反应,但对肺氧合及换气功能无明显影响。     

允许性高碳酸血症对单肺通气后肺功能及萎陷侧肺炎症反应的影响

目的观察允许性高碳酸血症对胸腔镜下肺叶切除术患者单肺通气后肺功能及萎陷侧肺炎症反应的影响。方法拟于胸腔镜下行肺叶切除术的患者50例,ASAⅡ或Ⅲ级,年龄38~65岁。患者随机分为两组,每组25例。术中维持PaCO_235~45mm Hg(C组)和55~65mm Hg(H组)。分别于单肺通气前1min(T_1)、单肺通气后30min(T_2)、萎陷肺复张后30min(T_3)抽取动脉血5ml,行动脉血气分析并计算呼吸指数(RI);收集外周静脉血及萎陷侧肺下叶肺泡灌洗液,检测TNF-α、IL-6和IL-10水平;记录气道峰压、潮气量、气道平台压,并计算动态肺顺应性(Cdyn)。结果与C组比较,T_2时H组气道峰压明显降低(P0.05);T_2、T_3时H组萎陷侧肺泡灌洗液IL-10水平和Cdyn明显升高(P0.05),TNF-α、IL-6水平、RI明显降低(P0.05)。结论允许性高碳酸血症能有效抑制肺叶切除术患者单肺通气后萎陷侧肺的炎症反应,改善肺脏弥散功能及顺应性。     

选择性肺叶隔离通气用于COPD老年患者开胸手术时的通气效果

目的 评价选择性肺叶隔离通气用于慢性阻塞性肺病(COPD)老年患者开胸手术时的通气效果.方法 择期拟行食管癌根治术合并COPD的老年患者30例,年龄65～80岁,体重指数16～ 28 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为2组(n=15):单肺通气组(OLV组)和选择性肺叶隔离通气组(SLC组).OLV组患者采用双腔气管导管实施单肺通气,SLC组患者使用支气管堵塞器堵塞肺叶支气管,实施选择性肺叶隔离通气.于平卧位双肺通气10 min(T0)、侧卧位单肺通气或选择性肺叶隔离通气5 min(T1)、45 min(T2)、90 min(T3)、术毕侧卧位双肺通气10 min(T4)时测定气道峰压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)和动态肺顺应性(Cd).于T0、T3、T4时采集动脉血样,行血气分析,计算氧合指数(OI)、肺泡-动脉血氧分压差[P(A-a)Q2]和呼吸指数(RI).结果 与OLV组比较,SLC组T2～4时Peak、Pplat及Raw降低,T1～4时Cd升高,T3,4时0I升高、P(A-a)O2和RI降低(P＜ 0.05或0.01).结论 COPD老年患者胸科手术时,单肺通气和选择性肺叶隔离通气均可安全完成手术,实施肺叶隔离通气能改善氧合,具有更好的通气效果.     

肺保护性通气策略对食管癌手术患者围术期炎症反应的影响

目的研究肺保护性通气策略对伴有肺功能异常的食管癌手术患者围术期炎症反应的影响。方法选择40例择期行食管癌根治术患者,术前肺功能检查有一项以上指标异常,随机均分为保护性通气组(PV组)和常规通气组(CV组)。双肺及单肺通气参数设定:PV组患者潮气量5~6ml/kg,吸呼比为1∶1,并给予呼气末正压(PEEP)3~5cmH2O。CV组患者潮气量10ml/kg,吸呼比为1∶1.5。在气管插管后(T1)、单肺通气120min(T2)、术后24h(T3)抽取静脉血3ml检测白细胞介素6(IL-6)及白细胞介素8(IL-8)的浓度;旁气流法监测气道峰压(Ppeak)、平台压(Pplat)、气道阻力(Raw)、动态胸肺顺应性(Cdyn);血气分析并计算出氧合指数(OI)。结果与T1时比较,两组T2、T3时IL-6、IL-8的浓度显著增加(P<0.05),但PV组增加幅度显著低于CV组(P<0.05)。PV组T2时Ppeak、Pplat、Raw显著低于CV组(P<0.05),而CV组Cdyn显著升高(P<0.05),PV组T2、T3时OI显著高于CV组(P<0.05)。结论肺保护性通气策略可有效降低肺功能异常患者机械通气时气道压力及阻力,减少炎性因子的释放,减轻围术期炎症反应。     

利用动态肺顺应性设定呼气末正压在胸腔镜肺叶切除术中的运用

目的 探讨单肺通气利用动态肺顺应性设定呼气末正压通气(positive end-expiratory pressure,PEEP)的优势及可行性. 方法 选择预行右侧肺叶切除患者80例,完全随机分为A组和B组,每组40例:A组,单肺通气实施肺膨胀(sustained inflation,SI)复张后加用20 cmH2O(1 cmH2O=0.098 kPa)的PEEP并递减滴定,随后以得到最大肺顺应性的PEEP值通气,直到恢复双肺通气;B组,通气PEEP值固定为5 cmH2O,其他通气方法同A组.记录患者血气、呼吸等参数. 结果 两组设定的PEEP值[A组(9.2±1.2) cmH2O,B组5 cmH2O]差异有统计学意义(P＜0.05);在单肺通气1 h(T3)、手术结束(T4)时,两组动脉血氧分压(partial pressure of oxygen,PaO2)比较,差异有统计学意义(P＜0.05);B组的PaO2在T3～T4逐步降低,差异有统计学意义(P＜0.05),而A组则维持较好(P＞0.05);T3、T4时刻A组的动态肺顺应性[(30.8±5.9)、(30.7±6.4) ml/cmH2O]与B组[(26.6±5.5)、(26.4±5.2) ml/cmH2O]比较,差异有统计学意义(P＜0.05). 结论 胸腔镜肺叶切除术中的单肺通气,利用动态肺顺应性设定的PEEP值通气能够得到更好的氧合及呼吸参数,并且维持较好.     

最佳呼吸末正压肺保护通气策略对腹腔镜下结直肠癌根治术患者氧合功能的影响

目的探讨最佳呼吸末正压(PEEP)肺保护通气策略对腹腔镜下结直肠癌根治术患者围术期氧合功能的影响。方法择期行腹腔镜下结直肠癌根治术患者54例,男36例,女18例,年龄65～85岁,ASAⅡ或Ⅲ级。随机分为两组:传统组(T组)和保护组(P组),每组27例。T组设置V_T 9 ml/kg且无PEEP和肺复张(RMs);P组通过肺动态顺应性(Cdyn)PEEP滴定确定患者最佳PEEP值,设置低V_T 7 ml/kg联合最佳PEEP,每30分钟RMs一次。于麻醉诱导后10 min(T_1)、每次RMs后30 min(T_2、T_3、T_4)记录Cdyn及气道平台压(Pplat)、并在T_1—T_4、拔管后30 min(T_5)及术后第3天(T_6)采集动脉血样本,计算氧合指数(OI),记录术前和T_6时的改良临床肺部感染评分(mCPIS)。结果与T组比较,T_3、T_4时P组Cdyn明显升高(P0.05),T_4—T_6时P组OI明显升高(P0.05),T_6时P组mCPIS明显降低(P0.05)。结论最佳PEEP联合低V_T和RMs的肺保护通气策略可改善腹腔镜结直肠癌根治术患者围术期氧合,降低mCPIS。     

COPD患者肺叶切除术时低潮气量通气的效果

目的 评价慢性阻塞性肺疾病(COPD)患者行肺叶切除术时低潮气量通气的效果.方法 择期行肺叶切除术的COPD患者28例,年龄65～84岁,ASA Ⅱ或Ⅲ级,随机分为常规潮气量组(TV组,n=14)和低潮气量组(LV组,n=14).均于气管插管后行机械通气,参数设置:TV组潮气量(VT)为10 ml/kg,呼气末正压(PEEP)为0;LV组Vr为5～6 ml/kg,PEEP为0～5 cm H2O.采用旁气流法监测气道峰压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)及动态肺顺应性(Cd).于平卧位双肺通气10 min(T1)、侧卧位单肺通气90 min(T2)、术毕平卧位双肺通气10 min(T3)及术后24 h(T4)时取桡动脉血样,行血气分析,计算氧合指数(OI)、肺泡.动脉血氧分压差[P(A-a)O2]及呼吸指数(RI);取颈内静脉血样,测定血清肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)的浓度.结果 与T1时比较,2组T2-4时血清TNF-α及IL-6浓度升高(P<0.05);与TV组比较,LV组T2-4时血清TNF-α及IL-6浓度降低(P<0.05),T1-3时Ppeak及Raw降低,T2.3时Cd升高(P<0.05).T1-4时2组OI、RI及P(A-a)O2差异无统计学意义(P0.05).结论 低VT,通气可通过降低炎性反应,减轻COPD患者肺叶切除术时机械通气诱发的肺损伤.     

术前雾化吸入布地奈德对开胸手术患者单肺通气时炎性反应的影响

目的 评价术前雾化吸入布地奈德对开胸手术患者单肺通气时炎性反应的影响.方法 肺叶切除术患者50例,年龄20 ～ 60岁,体重50 ～ 80 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组(n=25):对照组(C组)和布地奈德组(B组).术前C组雾化吸入生理盐水20 min;B组雾化吸入布地奈德1 mg 20 min.分别于单肺通气前(T1)、单肺通气结束后30 min(T2)、术后24 h(T3)和48 h(T4)时采集动脉血样,进行血气分析；采集静脉血样,采用ELISA法测定血清TNF-α、IL-1、IL-6、IL-8和IL-10的浓度.分别于T1和T2时,记录气道峰压、气道平台压和肺顺应性,采用ELISA测定支气管肺泡灌洗液TNF-α、IL-1、IL-6、IL-8和IL-10浓度.结果 与C组比较,B组T1和T2时气道峰压和气道平台压降低,肺顺应性升高,T2时支气管肺泡灌洗液中TNF-α、IL-1、IL-6和IL-8的浓度降低,T2-4时氧合指数升高,血清TNF-α、IL-1、IL-6和IL-8的浓度降低(P＜0.05),各时点PaCO2比较差异无统计学意义(P＞0.05).结论 术前雾化吸入布地奈德可抑制开胸手术患者单肺通气时的炎性反应,有助于改善肺功能.     

呼气末正压通气对腹腔热灌注化疗患者呼吸力学及肺功能的影响

目的探讨不同呼气末正压通气对腹腔热灌注化疗患者呼吸力学及肺功能的影响。方法选择择期行腹膜癌热灌注化疗的患者90例,男55例,女35例,年龄40~70岁,ASAⅠ~Ⅲ级。随机分为三组,每组30例。A组为容量控制通气(VCV)组,VT10 ml/kg;B组为VCV+低PEEP组,VT6ml/kg,PEEP 5cm H_2O;C组为VCV+高PEEP组,VT6ml/kg,PEEP 10cm H_2O;术中调整RR维持PETCO2 35~45 mm Hg。于气管插管后5 min(T_1)、腹腔热灌注化疗开始前(T2)、化疗结束时(T_3)、气管拔管前(T4)记录气道峰压(Ppeak)、气道平台压(Pplat)和平均气道压(Pmean),计算动态肺顺应性(C_(dyn))。并取桡动脉血进行血气分析,计算氧合指数(OI)、呼吸指数(RI)、肺泡-动脉血氧分压差(A-aDO_2)及死腔率(VD/VT)。记录术后7d内肺部相关并发症情况。结果与A组比较,T_1~T_4时B、C组Ppeak、Pplat、A-aDO_2和RI明显降低,OI和VD/VT明显升高(P0.05);T_2~T_4时B、C组Pmean明显降低,Cdyn和PaO_2明显升高(P0.05)。与T_1比较,T_2~T_4时A组Ppeak、Pplat和Pmean明显升高,C_(dyn)明显降低(P0.05);T_3时B组Ppeak和Pplat明显升高(P0.05),T_2~T_4 Pmean明显升高(P0.05),T3、T4时C_(dyn)明显降低(P0.05);T_2~T_4时C组Ppeak、Pplat和Pmean明显升高(P0.05),T_3、T_4时Cdyn明显降低(P0.05)。与T0时比较,T2~T4时三组PaO_2和OI明显降低,A-aDO_2、RI和VD/VT明显升高(P0.05)。术后7d内B、C组肺部感染、低氧血症和肺不张的发生率明显低于A组(P0.05)。结论小潮气量(6ml/kg)联合PEEP(5cm H_2O)通气可以显著改善腹膜癌患者术中热灌注期间肺功能,降低围术期肺部并发症的发生风险。     

高渗氯化钠对单肺通气时呼吸力学的影响

目的 探讨高渗氯化钠对单肺通气患者呼吸力学参数的影响.方法 选择拟单肺通气剖胸手术患者60例,随机均分为高渗氯化钠治疗组(H组)和对照组(C组).在单肺通气30 min后经中心静脉导管输注7.5％氯化钠溶液(H组)或生理盐水(C组)2 ml/kg.观察单肺通气前(T1)、单肺通气后30 min(T2)、输注后30 min(T3)、60 min(T4)、单肺通气结束时(T5)的动态肺顺应性(Cdyn)、气道峰压(Ppeak)、气道平均压(Pmean)、动脉血氧分压(PaO2)、血清Na+浓度.结果 与T1时比较,两组患者T2时的Cdyn、PaO2明显降低,Ppeak、Pmean明显升高(P＜0.05).与T2时比较,T3～Ts时H组Cdyn、PaO2逐渐升高,Ppeak、Pmean逐渐下降(P＜0.05),且Cdyn、PaO2明显高于C组,Ppeak明显低于C组(P＜0.05).T4、T5时H组Pmean明显低于C组(P＜0.05).结论 7.5％氯化钠溶液对单肺通气患者的各呼吸力学参数有改善作用,对肺通气功能具有保护作用.     

Respiration: ventilation

Anaesthetists and intensivists directly manipulate pulmonary function, in particular ventilation. A sound and thorough working knowledge of applied pulmonary physiology of ventilation is essential to the safe conduct of anaesthesia and intensive care medicine. This article discusses pulmonary anatomy, gas exchange in the lung, the mechanics of ventilation, airway resistance, elastance and compliance, the work of breathing and ventilation/perfusion relationships including hypoxic pulmonary vasoconstriction. General anaesthesia has profound effects on the respiratory system including the ventilatory response to hypercapnia and hypoxia, upper airway muscle function, lung volumes and ventilation/perfusion matching. Many surgical procedures are facilitated by one-lung ventilation. When utilizing one-lung ventilation a key aim for the anaesthetist is to maintain adequate alveolar ventilation while minimizing the amount of shunt through the non-ventilated lung. A detailed understanding of one-lung ventilation is therefore vital if a logical approach to management is to be adopted.     

不同通气模式对单肺通气影响的Meta分析

目的 采用Meta分析的方法评价压力控制通气(pressure controlled ventilation,PCV)与容量控制通气(volume controlled ventilation,VCV)对术中单肺通气(one lung ventilation,OLV)患者呼吸力学及循环的影响. 方法 检索PubMed、Embase、Cochrane图书馆,检索时间从建库至2016年2月.收集术中OLV使用PCV与VCV的临床随机对照试验(randomizedcontrolled trim,RCT).采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan 5.0软件对收集的患者资料进行Meta分析评价. 结果 共纳入14项研究,包括964例患者,其中PCV组480例,VCV组484例.与VCV组比较:在开胸前双肺通气时(T1),PCV组气道平均压(mean airway pressure,Pmean)比值比(odds ratio,OR)[0R=-0.22,95％CI(-0.42,-0.01),P＜0.05]较低;OLV时(T2),PCV组气道峰压(peak airway pressure,Ppeak)[加权均数差(weighted mean difference,WMD)=-1.37,95％CI(-1.69,-1.05)]及气道平台压(pause pressure,Plateau)较低[WMD=-0.29,95％CI(-0.51,-0.07)],而PaO2高[WMD=0.52,95％CI(0.08,0.95)];关胸后双肺通气时(T3),PCV组Ppeak较低[WMD=-0.63,95％CI(-1.09,0.17)]. 结论 与VCV比较,OLV期间PCV可提供较低的气道压,可能是一种较好的通气模式.     

Principles of artificial ventilation

The application of intermittent positive pressure ventilation (IPPV) during the 1952 Copenhagen polio epidemic led to the development of the world's first intensive care unit. The requirement for ventilatory support is the most common indication for intensive therapy unit (ITU) admission and is a defining feature of the specialty. Ventilator technology continues to develop and there are many ways to deliver IPPV. The variety of modes of ventilation is increasingly complex and expanding, without evidence that any one mode is associated with improved outcome. Ventilatory support is part of the treatment for a range of conditions including acute respiratory failure, raised intracranial pressure (ICP) and circulatory shock. Ventilator-associated lung injury is reduced by using low tidal volumes and limiting plateau airway pressure to less than 30 cmH₂O. Prolonged artificial ventilation has an associated morbidity and mortality and thus should be reviewed by an expert clinician on a daily basis. Weaning aims to identify those patients who will be able to breathe spontaneously. Protocols exist to facilitate timely extubation without the need for re-intubation.     

Principles of artificial ventilation

The application of intermittent positive pressure ventilation (IPPV) during the 1952 Copenhagen polio epidemic led to the development of the world’s first intensive care unit. The requirement for ventilatory support is the most common indication for intensive therapy unit (ITU) admission and is a defining feature of the specialty. Ventilator technology continues to develop and there are many ways to deliver IPPV. The variety of modes of ventilation is increasingly complex and expanding, without evidence that any one mode is associated with improved outcome. Ventilatory support is part of the treatment for a range of conditions including acute respiratory failure, raised intracranial pressure (ICP) and circulatory shock. Ventilator-associated lung injury is reduced by using low tidal volumes and limiting plateau airway pressure to less than 30 cmH₂O. Prolonged artificial ventilation has an associated morbidity and mortality and thus should be reviewed by an expert clinician on a daily basis. Weaning aims to identify those patients who will be able to breathe spontaneously. Protocols exist to facilitate timely extubation without the need for re-intubation.     

术侧肺部分通气法与单肺通气的比较研究

目的 与单肺通气(one-lung ventilation,OLV)比较术侧肺部分通气(partial ventilation of independent lung,PLV)情况下的氧合与气道压力.方法 16例接受食道手术的患者随机分为两组,进行自身对照交叉研究.在双肺通气后按不同顺序接受OLV和术侧肺PLV,比较3种通气时氧合指数(oxygen index,OI)及气道压力的变化.结果 两种通气方式下OI均显著低于双肺通气(two-lung ventilation,TLV),但PLV时显著高于OLV(PLV391±112,OLV134±53,TLV530±92,P<0.05);气道压力值在PLV时也显著低于OLV[Ppeak:(19±3)cm H2O vs(27±5)cm H2O,Pplat:(17±2)cm H2O vs(23±3)cm H2O,P<0.05](1 cm H2O=0.098 kPa). 结论PLV显著改善了氧合和呼吸力学指标.     

Pressure-controlled ventilation is superior to volume-controlled ventilation with a laryngeal mask airway in children

Background:  This prospective, randomized, crossover study had two purposes: first, to determine whether pressure-controlled ventilation (PCV) is safer than volume-controlled ventilation (VCV) by preventing gastric insufflation in children ventilated through an laryngeal mask airway (LMA); second, to assess whether the measurement of LMA leak pressure (P_leak) is useful for preventing leakage during positive pressure ventilation (PPV).
Methods:  Forty-one, 2 to 15-year-old children underwent general anesthesia with an LMA. The expiratory valve was set at 30 cmH₂O and P_leak was measured using constant gas flow. Children were randomly ventilated using PCV or VCV for 5 min in order to reach a P_ETCO₂ not exceeding 45 mm Hg, and then they were ventilated with the alternative mode. If the target P_ETCO₂ could not be obtained in one mode, we switched to the other. If both modes failed, children were intubated. Tidal volumes, P_ETCO₂ and airway pressures were noted and compared between modes. Gastric insufflation was checked by epigastric auscultation.
Results:  PCV provided more efficient ventilation than VCV, as targeted P_ETCO₂ was obtained without gastric insufflation using PCV in all cases except one, whereas VCV failed in three cases. No gastric insufflation occurred when ventilating below peak.
Conclusions:  These findings suggest that in the age group studied, PCV is more efficient than VCV for controlled ventilation with a laryngeal mask. Gastric insufflation did not occur with this mode.     

In what respect does high frequency positive pressure ventilation differ from conventional ventilation?

The original rationale for HFPPV was that under certain conditions adequate alveolar ventilation could be achieved with high ventilatory frequencies and small tidal volumes. It was theorized further that increased ventilatory frequencies and low tidal volumes would decrease the airway pressures, barotrauma, and cardiovascular and other systemic consequences seen with conventional mechanical ventilation. The first clinical applications of HFPPV were in bronchoscopy and laryngoscopy for diagnostic and/or therapeutic purposes. Apart from these endoscopic applications, volume-controlled HFPPV has been compared with conventional ventilation in upper abdominal surgery and coronary artery bypass grafting. The possible advantages of HFPPV over conventional volume-controlled ventilation in the intensive care setting are still unclear. Provided that the mean lung volumes are similar, oxygenation in acute respiratory failure is similar with both ventilation methods. Although the role of HFPPV in the management of pulmonary diseases still remains to be clarified, it does provide effective ventilation in selected types of patients needing ventilatory support. New modes of pressure-controlled ventilation have not resolved all clinical problems in severe ARDS and/or acute respiratory failure. The search for means of optimal ventilatory support with minimal complications must continue, as conventional ventilation does not always offer the best treatment.     

Respiration: ventilation

Ventilation is the process by which air moves into and out of the lungs and is made available for gas exchange across the alveolar-capillary membrane. Ventilation occurs automatically in a continuous rhythmic pattern without any conscious effort. It is controlled by both neural and chemical inputs and is concerned with the homeostasis of oxygen and carbon dioxide as well as having a role in acid–base balance. Inspiration is an active process. The diaphragm is the main muscle of inspiration, but other muscles can be involved. Expiration is normally a passive process during quiet breathing, but in certain disease processes may require energy expenditure. Resistance to gas flow in the airways is determined by a number of factors. Airway radius is the most important factor influencing resistance and gas flow changes from being turbulent to laminar as bronchi divide and cross-sectional area of the airways increases. Ventilation is not evenly distributed throughout the lungs and distribution is related to the compliance of alveoli in different areas of the lungs. Under normal circumstances, in the standing position, basal alveoli are the most compliant and are therefore preferentially ventilated.     

单肺通气时机械通气模式的研究进展

背景 单肺通气(one lung ventilation,OLV)实施过程中最常见的并发症是低氧血症,也是麻醉医师遇到的最严重的挑战. 目的 近来研究表明OLV本身能够引起低氧血症和急性肺损伤(acute lung injury,ALI).因此,如何实施OLV时机械通气模式,降低肺内分流率(pulmonary shunt fraction,Qs/Qt)、预防低氧血症一直是临床研究的热点. 内容 综述提高吸入氧分数(fraction of inspiration O2,FiO2)、控制通气模式、高频通气(high frequency ventilation,HFV)、潮气量(tidal volume,Vt)、反比通气、部分液体通气(partial liquid ventilation,PLV)、持续气道正压通气(continuous positive airway pressure,CPAP)、呼气末正压通气(positive end-expiratory pressure,PEEP)等通气模式,以及实施联合多种模式的保护性肺通气策略. 趋向 综合运用多种预防OLV期间低氧血症的通气模式取得良好的效果,但应针对患者和手术情况制定OLV时机械通气模式.