单肺通气时PETCO2与PaCO2的关系

对２６例ＡＳＡＩ～Ⅱ级开胸肺手术的患者，分为Ａ、Ｂ两组，分别以双肺通气（ＴＬＶ）为对照行单肺通气（ＯＴＶ）或ＯＴＶ ＋术侧肺用Ｂａｉｎ回路行ＣＰＡＰ，测量ＴＬＶ３０分，ＯＬＶ３０分、６０分和Ｒ－ＴＬＶ３０分的ＰＥＴＣＯ２和ＰａＣＯ２值，观察两者的关系。结果表明，两组中ＯＬＶ时的ＰＥＴＣＯ２和ＰａＣＯ２均正常，但较ＴＬＶ时有升高的趋势（Ｐ＜０．０５），Ｒ－ＴＬＶ后又复原（Ｐ＞０．０５）；两组间ＯＬＶ时的测量值无差异（Ｐ＞０．０５），而ＰＥＴＣＯ２与Ｐ。ＣＯ２有密切的相关性（Ｐ＜０．０５）；Ｐ（ａ－ＥＴ）ＣＯ２和ＰＥＴＣＯ２的计算值在不同通气时无显著性差异，说明ＰＥＴＣＯ２可作为一种无创监测手段指导ＯＬＶ时的通气效果。     

静脉注射不同剂量异丙酚对血流动力学及通气功能的影响

应用阻抗法和分气流监测法观察静脉注射不同剂量异丙酚（Ｐｒｏｐｏｆｏｌ，ＰＲＯ）后患者血流动力学（ＭＡＰ、ＮＲ、ＳＬＣＩ、ＩＦＩ、ＶＥＴ、ＥＶＩ、ＳＶＲＩ、ＩＣ、ＰＦＩ、ＬＳＷＩ）与通气功能（ＶＴ、ＲＲ、ＶＥ、ＦＥＶ１％、ＥＴＣＯ２、ＳＰＯ２、 Ｉ－ＥｔＯ２）的变化。 ４０例（ＡＳＡⅠ～ Ⅱ）随机分成四组，ＰＲＯ剂量分别为 １．０ｍｇ／ｋｇ、１．５ｍｇ／ｋｇ、２．０ｍｇ／ｋｇ、２．５ｍｇ／ｋｇ。结果：（１）１～４组呼吸暂停发生率为０％、２０％、３０％、８０％，苏醒时间分别为３ ０±１．５、７．４±２．３、９．１±３．６、９．６±４．２分钟：（２）静脉注射不同剂量ＰＲＯ启ＳＡＰ、ＤＡＰ、ＭＡＰ、ＳＩ下降，ＨＲ、ＣＩ、ＳＶＲＩ无明显变化，心肌收缩性（ＩＣ、ＰＦＩ、ＥＶＩ）明显减弱，ＳＶＲＩ减少；（３）ＰＲＯ对呼吸有抑制作用，以ＶＴ和ＶＥ影响最大，与剂量呈正相关；对面罩吸氧患者ＳｐＯ２、ＲＲ、ＥＴＣＯ２无明显改变，Ｉ－ＥｔＯ２减少；舌后坠者托起下颌对ＶＴ、ＶＥ的恢复颇为有效。     

单肺通气期间提高PETCO2反映PaCO2准确性的研究

目的：探讨单肺通气期间影响ＰＥＴＣＯ的因素及如何提高ＰＥＴＣＯ２反映ＰａＣＯ２的准确性。方法：对２７例患者进行了临床研究。结果：（１）肺内分流（Ｑｓ／Ｑｔ）量显著影响ＰＥＴＣＯ２；（２）机械通气参数中，ＶＴ对其影响最大，其他依次为ＲＲ、ＦＩＯ２和Ｉ／Ｅ。结论：单肺通气较合理的参数为ＶＴ１０ｍｌ／ｋｇ，ＲＲ１２次／分，ＦＩＯ２０．８及Ｉ／Ｅ１２。     

双频指数在芬太尼体外循环麻醉中的观察

本研究将脑电双频指数 (ＢＩＳ)应用于芬太尼全麻低温体外循环术中监测 ,试图分析其在该类手术中的应用价值。资料与方法一般资料　体外循环下心脏瓣膜置换手术病人 2 0例 ,其中二尖瓣置换术 14例 ;主动脉瓣置换 6例。ＡＳＡ分级Ⅱ～Ⅲ ,无神经系统病史 ,无酗酒及长期药物使用史。随机分为非ＢＩＳ控制组 (Ａ组 )和ＢＩＳ控制组 (Ｂ组 ) ,每组各 10例。麻醉与监测　入手术室后连接ＡＳＰＥＣＴ 2 0 0 0型ＢＩＳ监测仪 ,开机自检 ,确定电极接触良好。监测记录ＢＩＳ、ＢＰ、ＭＡＰ、ＣＶＰ、ＳＰＯ2 、ＰＥＴＣＯ2 及口咽温度 ,应用肌松监测…     

大剂量安定与硫喷妥钠—安定诱导对心瓣膜手术病人血流动力…

对４３例ＣＰＢ下心瓣膜直视手术病人进行了血流动力学监测，其中采用大剂量安定诱导（Ｉ组）２２例，硫喷妥钠－安定诱导（Ⅱ组）２１例，诱导后，两组ＣＩ，ＭＰＡＰ，ＰＴＲＩ，ＬＶＷＩ及ＲＶＷＩ均降低，Ｉ组尚伴ＨＲ，ＭＡＰ，ＰＣＷＰ和ＰＶＲＩ下降，Ⅱ组ＲＡＰ及ＳＶＲＩ增加，气管插管后，两组ＲＡＰ，ＰＩＲＩ及ＳＶＲＩ显著增高Ｉ组ＭＡＰ，ＭＰＡＰ，ＰＣＷＰ增高，Ⅱ组ＣＩ下降，锯胸骨后，Ⅱ组ＣＩ，ＬＶＷＩ及ＲＶＷ     

大剂量安定与硫喷妥钠-安定诱导对心瓣膜手术病人血流动力学的影响

对４３例ＣＰＢ下心瓣膜直视手术病人进行了血流动力学监测。其中采用大剂量安定诱导（Ⅰ组）２２例，硫喷妥钠－安定诱导（Ⅱ组）２１例。诱导后，两组ＣＩ、ＭＰＡＰ、ＰＴＲＩ、ＬＶＷＩ及ＲＶＷＩ均降低，Ⅰ组尚伴ＨＲ、ＭＡＰ、ＰＣＷＰ和ＰＶＲＩ下降，Ⅱ组ＲＡＰ及ＳＶＲＩ增加；气管插管后，两组ＲＡＰ、ＰＩＲＩ及ＳＶＲＩ显著增高，Ⅰ组ＭＡＰ、ＭＰＡＰ、ＰＣＷＰ增高，Ⅱ组ＣＩ下降；锯胸骨后，Ⅱ组ＣＩ、ＬＶＷＩ及ＲＶＷＩ进一步降低。结果表明大剂量安定诱导对心瓣膜病人循环功能抑制较轻微，且明显降低肺血管压力及阻力，但对气管插管应激反应抑制差；硫喷妥钠－安定诱导，虽对插管应激反应抑制较佳，但可进一步损害此类病人的循环功能；吸入１％以内异氟醚维持麻醉，可使ＳＶＲ降低，对“高阻低排”血流动力学状况的心脏病人有利。     

不同剂量异丙酚和硫喷妥钠静脉注射对血流动力学的影响

目的：研究异丙酚对血流动力学影响。方法：３０例病人（ＡＳＡⅠ～Ⅱ级）随机分为三组，第１组硫喷妥钠用量为５ｍｇ／ｋｇ，第２、３组异丙酚剂量分别为１．５ｍｇ／ｋｇ和２．５ｍｇ／ｋｇ，用阻抗法观察ＭＡＰ、ＨＲ、ＣＯ、ＣＩ、ＳＶ、ＳＩ、ＴＦＩ、ＶＥＴ、ＳＶＲ的变化。结果：注药后１０ｍｉｎＣＯ、ＣＩ、ＳＶ、ＳＩ等值在第１组下降２０％～３０％，第２组下降少于１０％，而第３组下降１０％～２０％。结论：异丙酚对循环系统影响轻于硫喷妥钠。     

腹腔镜胆囊切除术与循环呼吸功能变化

腹腔镜胆囊切除术循环功能变化是ＣＯ２气腹后即时ＣＩ降低。头高位对循环影响，ＭＡＰ，ＳＶＲ升高。呼吸功能变化的胞肺顺应性、ＦＲＣ降低，ＰａＯ２无明显变化，ＳｖＯ２下降，ＰａＣＯ２增高。可发生通气障碍，节段性肺不张。ＡＳＡⅢ－Ⅳ病人强调监测ＣＩ，ＳｖＯ２，吸气平台压，ＰａＣＯ２。     

咪唑安定硬膜外注射时患者血流动力学及通气功能变化

咪唑安定（ＭＩＤ）硬膜外注射的节段性镇痛效应及其对患者血流动力学（ＭＡＰ、ＨＲ、ＳＩ、ＣＩ、ＴＦＩ、ＶＥＴ、ＥＶＩ、ＳＶＲＩ、ＩＣ、ＰＥＩ、ＬＶＷＩ、ＲＰＰ）与通气功能（ＶＴ、ＲＲ、ＶＥ、ＦＥＶ１、Ｉ－ＥｔＯ２、ＰＥＴＣＯ２、ＳｐＯ２）的影响。４４例患者随机分成四组：Ｅ１组硬外注ＭＩＤ０．０５ｍｇ／ｋｇ，Ｅ２组硬外注ＭＩＤ０．１ｍｇ／ｋｇ，Ｖ１、Ｖ２组为静脉组，剂量与Ｅ１、Ｅ２组相同。结果：（１）     

对于严重股骨骨质溶解应用带骨水泥的CHARNLEY翻修关节成形术

对于严重股骨骨质溶解应用带骨水泥的ＣＨＡＲＮＬＥＹ翻修关节成形术ＣＥＭＥＮＴＥＤＣＨＡＲＮＬＥＹＲＥＶＩＳＩＯＮＡＲＴＨＲＯＰＬＡＳＴＹＦＯＲＳＥＶＥＲＥＦＥＭＯＲＡＬＯＳＴＥＯＬＹＳＩＳＶＶＲＡＵＴ，ＰＤＳＩＮＥＹ，ＢＭＷＲＯＢＬＥＷＳＫＩ我们对１...     

经胸腔镜肺大泡切除术中应用单肺通气对血气及血液动力学的影响

目的　观察胸腔镜手术中单肺通气时应用不同水平的呼气末正压通气 (PEEP)对血气及血液动力学的影响。方法　随机选择胸腔镜肺大泡切除术病人 36例 ,均分为三组 :A组为单肺间歇正压通气 (IPPV)通气 ;B组为单肺IPPV加PEEP 5cmH2 O通气 ;C组为单肺IPPV加PEEP10cmH2 O通气。分别记录平卧位双肺通气、侧卧位双肺通气、单肺通气 10min和 30min四个时点的血气和血液动力学参数。结果　各组病人SpO2 始终维持在 99%～ 10 0 %。动脉血氧分压 (PaO2 )也在正常范围 ,但B、C组明显高于A组 (P <0 .0 5 )。其余血气指标无明显变化。三组病人HR、MAP、左心室射血时间 (LVET)及体循环血管阻力 (SVR)均无明显变化。B、C组在单肺通气 10min及 30min后 ,每搏量 (SV)及心输出量 (CO)下降明显 ,但均在正常范围 ,且无组间差异。体位改变时血液动力学稳定。结论　经胸腔镜肺大泡切除术中单肺IPPV、PEEP 5cmH2 O均能维持满意的PaO2 和动脉血二氧化碳分压 (PaCO2 ) ,血液动力学变化不显著 ;但PEEP 5cmH2 O较IPPV能进一步提高PaO2 ,PEEP 10cmH2 O不能较PEEP 5cmH2 O进一步提高PaO2 。     

The effect of timing of application of positive end-expiratory pressure on oxygenation during one-lung ventilation

Many studies have confirmed that applying positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation (OLV) improves oxygenation. Our purpose was to investigate the best time and level of PEEP application. Thirty patients undergoing thoracic surgery were randomised into three groups. After 20 minutes of two-lung ventilation (TLV) in the lateral position, all patients received OLV for one hour During OLV, 0, 5, 10 cmH2O PEEP were applied in order in group A, with each level sustained for 20 minutes. Group B had 5 cmH2O PEEP applied and maintained for one hour Patients in group C received PEEP with levels set in the opposite order to that of group A. The ventilation model was then converted to TLV. PaO2, PaCO2 and respiratory mechanical variables were compared at five different time points among groups, 20 minutes after TLV (T1), 20 (T2), 40 (T3) and 60 minutes (T4) after OLV and 20 minutes after conversion to TLV (T5). We found that PaO2 was lower in group A than the other two groups at T2 (P <0.05). PaO2 decreased significantly at T5 compared with T1 (P <0.05) in group A only. When PEEP was set to 10 cmH2O, the airway pressure increased significantly (P <0.05). These findings indicate that PEEP applied at the initial time of OLV improves oxygenation most beneficially. Five cmH2O PEEP may produce this beneficial effect without the increase in airway pressure associated with 10 cmH2O PEEP.     

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.     

Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum

BACKGROUND: Laparoscopic surgery usually requires the use of a pneumoperitoneum by insufflating gas in the peritoneal space. The gas most commonly used for insufflation is carbon dioxide. Increased intra-abdominal pressure causes cephalad displacement of the diaphragm resulting in compressed lung areas, which leads to formation of atelectasis, especially during mechanical ventilation. The aim of this prospective study was to investigate the effect of prolonged intraperitoneal gas insufflation on arterial oxygenation and hemodynamics during mechanical ventilation with and without positive end-expiratory pressure (PEEP). METHODS: Twenty patients undergoing totally endoscopic robot-assisted radical prostatectomy were randomly allocated to one of two groups. In the PEEP group (n = 10) a constant PEEP of 5 cmH(2)O was used, whereas in the ZPEEP group (n = 10) no PEEP was used. RESULTS: Application of PEEP (5 cmH(2)O) resulted in significantly higher P(a)O(2) levels after 3 h (182 +/- 49 vs. 224 +/- 35 mmHg) and 4 h (179 +/- 48 vs. 229 +/- 29 mmHg) of pneumoperitoneum; after desufflation, P(a)O(2) values decreased significantly below preinsufflation values. While there were no significant differences in heart rate, central venous pressure (CVP) and mean arterial blood pressure (MAP) during pneumoperitoneum between both groups, baseline values in CVP and MAP differed significantly between both groups with higher levels in the ZPEEP group. CONCLUSION: The application of a constant positive airway pressure of 5 cmH(2)O preserves arterial oxygenation during prolonged pneumoperitoneum.     

Effect of PEEP and inhaled nitric oxide on pulmonary gas exchange during gaseous and partial liquid ventilation with small volumes of perfluorocarbon

BACKGROUND: Partial liquid ventilation, positive end-expiratory pressure (PEEP) and inhaled nitric oxide (NO) can improve ventilation/perfusion mismatch in acute lung injury (ALI). The aim of the present study was to compare gas exchange and hemodynamics in experimental ALI during gaseous and partial liquid ventilation at two different levels of PEEP, with and without the inhalation of nitric oxide. METHODS: Seven pigs (24+/-2 kg BW) were surfactant-depleted by repeated lung lavage with saline. Gas exchange and hemodynamic parameters were assessed in all animals during gaseous and subsequent partial liquid ventilation at two levels of PEEP (5 and 15 cmH2O) and intermittent inhalation of 10 ppm NO. RESULTS: Arterial oxygenation increased significantly with a simultaneous decrease in cardiac output when PEEP 15 cmH2O was applied during gaseous and partial liquid ventilation. All other hemodynamic parameters revealed no relevant changes. Inhalation of NO and instillation of perfluorocarbon had no additive effects on pulmonary gas exchange when compared to PEEP 15 cmH2O alone. CONCLUSION: In experimental lung injury, improvements in gas exchange are most distinct during mechanical ventilation with PEEP 15 cmH2O without significantly impairing hemodynamics. Partial liquid ventilation and inhaled NO did not cause an additive increase of PaO2.     

胸科手术中单肺通气期间不同通气方式的比较

目的 观察胸科手术病人麻醉中单肺通气（ＯＬＶ）期间不同通气方式的效果。方法 １０例择期胸科手术成年病人,ＡＳＡⅠ～Ⅱ级,在ＯＬＶ期间首先采用全潮气量（１０ｍｌ／ｋｇ）不加ＰＥＥＰ,随后采用半潮气量（５ｍｌ／ｋｇ）同时施加７ｃｍＨ２Ｏ ＰＥＥＰ两种通气方式,保持每分通气量不变。在开胸后ＯＬＶ前,ＯＬＶ时采用敏种通气方式后３０ｍｉｎ,以及恢复双肺通气（ＴＬＶ）后３０ｍｉｎ分别进行血气分析,同时监测气道     

One-lung ventilation with high tidal volumes and zero positive end-expiratory pressure is injurious in the isolated rabbit lung model

We tested the hypothesis that one-lung ventilation (OLV) with high tidal volumes (VT) and zero positive end-expiratory pressure (PEEP) may lead to ventilator-induced lung injury. In an isolated, perfused rabbit lung model, VT and PEEP were set to avoid lung collapse and overdistension in both lungs, resulting in a straight pressure-time (P-vs-t) curve during constant flow. Animals were randomized to (a) nonprotective OLV (left lung) (n = 6), with VT values as high as before randomization and zero PEEP; (b) protective OLV (left lung) (n = 6), with 50% reduction of VT and maintenance of PEEP as before randomization; and (c) control group (n = 6), with ventilation of two lungs as before randomization. The nonprotective OLV was associated with significantly smaller degrees of collapse and overdistension in the ventilated lung (P < 0.001). Peak inspiratory pressure values were higher in the nonprotective OLV group (P < 0.001) and increased progressively throughout the observation period (P < 0.01). The mean pulmonary artery pressure and lung weight gain values, as well as the concentration of thromboxane B(2), were comparatively higher in the nonprotective OLV group (P < 0.05). A ventilatory strategy with VT values as high as those used in the clinical setting and zero PEEP leads to ventilator-induced lung injury in this model of OLV, but this can be minimized with VT and PEEP values set to avoid lung overdistension and collapse. IMPLICATIONS: One-lung ventilation with high tidal volumes and zero positive end-expiratory pressure (PEEP) is injurious in the isolated rabbit lung model. A ventilatory strategy with tidal volumes and PEEP set to avoid lung overdistension and collapse minimizes lung injury during one-lung ventilation in this model.     

呼气末正压对不同血容量状态猪颅高压模型颅内压和脑氧代谢影响的实验研究

目的:观察不同血容量状态下颅高压的急性呼吸窘迫综合征(ARDS)猪模型,增加呼气末正压(PEEP)后,其血流动力学状态、颅内压(ICP)及脑氧分压(PtiO 2)的变化。 方法:选取雄性14～16月龄巴马小型猪12头,随机数字表法随机分成低血容量组和正常血容量组。建立ARDS和颅高压模型。自5 c...     

The evaluation of incremental positive end-expiratory pressure on right ventricular hemodynamics as determined by the thermodilution technique

Effects of incremental positive end-expiratory pressure (PEEP) on right ventricular (RV) hemodynamics were studied in 10 patients undergoing coronary artery bypass grafting, abdominal aneurysmectomy and partial hepatectomy, using Swan-Ganz catheter mounted with the rapid response thermistor. PEEP was increased from 0 (baseline) to 15 cmH2O with increment of 5 cmH2O, and right ventricular ejection fraction (RVEF), RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), and cardiac output (CO) were computed with a thermodilution technique at each PEEP. At 15 cmH2O PEEP, RVEF, RVEDVI and RVESVI were comparable with the baseline, while right arterial pressure, RV peak systolic pressure and mean pulmonary arterial pressure increased significantly compared with the baseline. Increased afterload of RN caused by PEEP did not affect RV contractility. Decreased cardiac and stroke volume indices were attributed to the decrease of preload caused by the increase of intrathoracic pressure. We conclude that PEEP at 5 to 15 cmH2O does not influence right ventricular hemodynamics, and RVEDV is a reliable index to monitor RV hemodynamics instead of right arterial pressure to determine optimal PEEP.     

Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration

BACKGROUND: General anaesthesia impairs the gas exchange in the lungs, and moderate desaturation (SaO2 86-90%) occurred in 50% of anaesthetised patients in a blinded pulse oximetry study. A high FiO2 might reduce the risk of hypoxaemia, but can also promote atelectasis. We hypothesised that a moderate positive end-expiratory pressure (PEEP) level of 10 cmH2O can prevent atelectasis during ventilation with an FiO2 = 1.0. METHODS: Atelectasis was evaluated by computed tomography (CT) in 13 ASA I-II patients undergoing elective surgery. CT scans were obtained before and 15 min after induction of anaesthesia. Then, recruitment of collapsed lung tissue was performed as a "vital capacity manoeuvre" (VCM, inspiration with Paw = 40 cmH2O for 15 s), and a CT scan was obtained at the end of the VCM. Thereafter, PEEP = 0 cmH2O was applied in group 1, and PEEP = 10 cmH2O in group 2. Additional CT scans were obtained after the VCM. Oxygenation was measured before and after the VCM. RESULTS: Atelectasis (> 1 cm2) was present in 12 of the 13 patients after induction of anaesthesia. At 5 and 10 min after the VCM, atelectasis was significantly smaller in group 2 than group 1 (P < 0.005). A significant inverse correlation was found between PaO2 and atelectasis. CONCLUSIONS: PEEP = 10 cmH2O reduced atelectasis formation after a VCM, when FiO2 = 1.0 was used. Thus, a VCM followed by PEEP = 10 cmH2O should be considered when patients are ventilated with a high FiO2 and gas exchange is impaired.