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.

Use of dynamic compliance identify the positive end-expiratory pressure level in the video-assisted pulmonary lobectomy

Objective To establish the advantage and feasibility of using dynamic compliance identify the positive endexpiratory pressure (PEEP) level in one lung ventilation.Methods Eighty patients undergoing video-assisted right pulmonary lobectomy were randomly allocated to two groups.Group A received an alveolar recruitment sustained inflation(SI) at the beginning of one-tung ventilation,then ventilated with an individualized PEEP level determined by a PEEP decrement trial which use dynamic compliance.After the same alveolar recruitment with group A,group B was ventilated with 5 cmH2O (1 cmH2O=0.098 kPa) PEEP.Arterial blood gas analysis,lung mechanics were recorded at 5 time points throughout the procedure.Results The PEEP values [group A (9.2±1.2) cmH2O,group B 5 cmH2O]was significantly different between two groups (P＜O.05),partial pressure of oxygen (PaO2) at T3 (1 h after one lung ventilation)、T4 (operation ending) was significantly different in two groups[group A (244t71) mmHg (1 mmHg=0.133 kPa),(240t63) mmHg,group B (212±61),(188±50) mmHg)(P＜0.05)],During one-lung ventilation,PaO2 at T3,T4was decreased in group B(P＜0.05),but it was maintained in group A (P＞0.05).The dynamic compliance have the same results[group A:T3 (30.8±5.9) ml/cmH2O,T4 (30.7±6.4) ml/cmH2O),group B[T3(26.6±5.5) ml/cmH2O,T4(26.4±5.2) ml/cmH2O(P＜0.05)].Conclusions The PO2 and lung mechanics were better maintained by using PEEP with decrement trial than 5 cmH2O PEEP during one-lung ventilation that undergoing video-assisted pulmonary lobectomy.