保护性涨肺对食管癌根治术高血压老年患者的影响

目的：观察保护性涨肺措施对食管癌根治术高血压老年患者血流动力学等指标的影响。方法将30例择期左侧开胸食管癌根治术老年高血压患者随机均分成C组和P组，每组15例。丙泊酚靶控输注静脉诱导与维持麻醉，行右单肺通气（OLV）。根据有创平均动脉压（MAP）、每搏量变异度（SVV）、心脏指数（CI）作目标导向液体治疗。关胸前恢复双肺通气（TLV），C组采用常规涨肺：以手控涨肺，气道峰压（Ppeak）20 cmH2O持续5 s，间断3 s；P组采用保护性涨肺：在机械通气潮气量10 mL／kg，呼吸频率12次／min 5个循环后，启动手控涨肺。记录恢复TLV前即刻（ TLV前），TLV后1～10 min（ TLV 1～10 min）的外周动脉心输出量（ CO）、每搏输出量（ SV）、SVV、CI，C组记录前10次手控涨肺结束时的MAP、心率（ HR）、Ppeak和中心静脉压（ CVP），P组记录5次机械通气吸气末和5次手控涨肺结束时的数据。结果两组患者OLV时的氧合指标，涨肺期间的HR、SVV差异无统计学意义。 C组肺完全复张需时短于P组。 P组前5次涨肺时的MAP高于C组，Ppeak和CVP 低于C组；在TLV 1～4 min的CO、SV、CI高于C组。 C组在TLV 1～4 min的CO、SV、CI及涨肺结束时的MAP低于TLV前；术后第1天，P组的动脉氧分压、氧合指数高于C组，脑钠肽前体低于C组（ P＜0.05， P＜0.01）。结论以机械通气过渡的保护性涨肺策略可维持患者血流动力学的稳定，改善术后氧合。

Effect of protective reinflation in elderly patients with hypertension undergoing radical esophagectomy

Objective To observe the effect of protective reinflation on hemodynamic variables in elderly patients with hypertension undergoing radical esophagectomy.Methods 30 elderly patients scheduled for left -sided radical esophagectomy were allocated randomly to two groups:Group C or Group P ( n=15 each) .Anesthesia was induced and maintained with propofol by target controlled infusion, a right-sided double-lumen endobronchial tube was placed for one lung ventilation (OLV).Mean arterial blood pressure (MAP), cardiac output(CO), stroke volume (SV), stroke volume variation( SVV) and cardiac index( CI) were recorded by Vigileo-FloTrac system.Goal-directed fluid therapy was based on SVV, CI and MAP.Ventilation mode was switched to two lung ventilation ( TLV) before closure of the pleu-ra, when manual reinflation of the left lung within 5 s at a peak inspiratory airway pressure ( Ppeak) of 20 cmH2 O and a pause of 3 s in Group C.In Group P, 5 episodes of mechanical ventilation with a tidal volume of 10 mL/kg and a respira-tory rate of 12 bpm was performed before manual reinflation of the left lung with the same measure as in Group C.The var-iables recorded were CO, SV, CI, and SVV before and 1 min to 10 min after TLV ( TLV 1-10 min) .MAP, heart rate ( HR) , Ppeak and central venous pressure ( CVP) after 10 episodes of manual reinflation in Group C, and data of 5 epi-sodes of mechanical ventilation and 5 episodes of manual reinflation in Group P were also recoreded.Results The groups were comparable with regard to arterial blood gas analysis, HR and SVV during OLV.Time required to complete reinfla-tion of the left lung was longer in Group P.MAP in Group P was higher than in Group C and Ppeak, CVP in Group P was lower than in Group C in 5 episodes of mechanical ventilation after TLV.CO, SV and CI of Group P was higher than Group C from TLV 1 min to TLV 4 min.In Group C, CO, SV and CI from TLV 1 min to TLV 4 min and MAP after each episode of reinflation were lower than those before TLV.Significant trends were found toward a lower level of pro-brain natriuretic peptide and a higher level of PaO2 , as well as higher PaO2/FiO2 -ratio in Group P compared with those of Group C in the first postoperative day (P<0.05 or <0.01).Conclusion Manual reinflation following the mechanical ventilatory strategy provides a stable hemodynamic during surgery and a better postoperative oxygenation for elderly patients with hypertension.