单肺通气对心功能和血流动力学的影响

 目的 探讨胸外科手术中单肺通气对患者心功能及血流动力学的影响。方法 选择美国麻醉医师协会(American of society anesthesiologists,ASA)分级Ⅰ~Ⅱ级,择期全身麻醉下侧卧位行双腔气管插管手术患者101例。应用FloTrac/Vigileo系统监测患者各项血流动力学参数。记录时间点分别为患者入室后(T₀)、插管后仰卧位双肺5 min(T₁)、侧卧位双肺5 min(T₂)、侧卧位单肺5 min(T₃)、侧卧位单肺10 min(T₄)、侧卧位单肺30 min(T₅)、侧卧位单肺60 min(T₆)、鼓肺后(T₇)、平卧位双肺5 min(T₈)。结果 T₀时MAP、HR高于T₂(P<0.05);T₁时SVR高于T₆(P<0.05);T₁、T₂时MAP、HR、CO、CI低于T₃(P<0.05);T₃时MAP高于T₄,HR低于T₄(P<0.05);T₅时SpO₂最低(P<0.05);T₆时HR高于T₇,MAP、SV低于T₇(P<0.05),余比较无统计学差异。结论 单肺通气后,患者出现短暂的血流动力学不稳,与双肺通气时比较MAP、HR、CO、CI增高,SpO₂、SVR减低,但随着单肺通气时间延长,各指标逐渐达到平稳状态。

Influence of one lung ventilation on cardiac function and hemodynamic status

Objective To evaluate the effect of one lung ventilation (OLV)on patient’s cardiac function and hemodynamic status during thoracic surgery by FloTrac/Vigileo system.Methods A total of 101 class Ⅰ-Ⅱ adult patients by American Society of Anesthesiologists (ASA) who had undergone the double lumen endotracheal intubation in the lateral position during thoracic surgery were enrolled in this study. Each hemodynamic parameter was recorded by FloTrac /Vigileo system at different time points that included the time before anesthesia induction(T₀), 5 min into intubation in the supine position by two lung ventilation (T₁) , 5 min after the lateral position by two lung ventilation(T₂),5 min after OLV (T₃) ,10 min after OLV(T₄) , 30 min after OLV(T₅), 60 min after OLV(T₆) ,after lung inflation (T₇),and 5 min after the supine position by two lung ventilation (T₈).Results MAP and HR were higher at T₀ than at T2 (P<0.05).SVR was higher at T₁ than at T₆ (P<0.05).MAP, HR, CO and CI were lower at T₁、T₃ than at T₄ (P<0.05). MAP was higher at T₂ than at T₄, and HR was lower at T₃ than at T₄ (P<0.05). SpO₂ was the lowest at T₅ (P<0.05). HR was higher at T₆ than at T₇, while MAP and SV were lower at T₆ than at T₇ (P<0.05).Conclusions After one lung ventilation, patients can experience transient hemodynamic instability, for MAP, HR, CO and CI tend to increase while SpO₂ and SVR tend to decrease compared with double lung ventilation. However, as the one lung ventilation continues, the indicators gradually become stable.