双侧肺同期手术中保护性单肺通气策略定容和定压通气的比较

目的探讨双侧肺同期手术单肺通气（OLV）期间采用定容（VCV）和定压（PCV）不同通气模式对呼吸力学及动脉血气的影响，并评价其临床效果。方法9例双侧肺同期手术患者，双肺通气（TLV）期间均采用VCV模式（TLV—VCV），OLV后通气侧肺先采用传统方法大潮气量（10ml／kg）通气（OLV—VCV1），30min后改为单肺保护通气：小潮气量（6～8ml／kg）＋PEEP的通气模式（OLV—VCV2）；或PCV＋PEEP的通气模式（OLV—PCV）。用旁气流通气监测法（SSS）监测呼吸力学参数：气道峰压（Ppeak）、气道平台压（Pplat）、气道阻力（Raw）、动态胸肺顺应性（Cdyn）、分钟通气量（MV）等。同时抽动脉血做血气分析。结果单肺保护通气时，Ppeak、Pplat、Raw较低，Cdyn相对较好（P均〈0．05）。PaO2及PaCO2显著升高（P〈0．05），但PaCO2的升高在临床允许范围内。结论双侧肺同期手术在实行单肺保护通气策略时，OLV—PCV和OLV—VCV2通气模式均可改善肺泡氧舍，预防和减轻单肺通气造成的低氧血症，还可以有效地降低气道压力、气道阻力，但PCV模式控制气道压更有效，更有利于减少气道损伤。

Comparison of volume controlled ventilation and pressure controlled ventilation of one-lung protective ventilation strategy during bilateral pulmonary surgery at the same period

Objective To investigate the signifieance and effect of pressure controlled ventilation （PCV） and volume controlled ventilation （VCV） of one-lung protective ventilation strategy on respiratory mechanics and arterial blood gas in patients who underwent bilateral pulmonary surgery at the same period. Methods Nine patients who underwent bilateral pulmonary surgery at the same period were mechanically ventilated with VCV during two-lung ventilation （ TLV ） and during one-lung ventilation （ OLV ） , these patients were mechanically ventilated with traditional VCV for 30rain at first,then with one-lung protective ventilation：tidal volume 6 - 8ml/kg and PEEP or pressure controlled ventilation and PEEP. The respiratory mechanics and arterial blood gases analysis were performed at the end of each ventilation mode. Results The airway peak pressure, the airway plat pressure and the airway resistance were significantly higher in traditional OLV-VCV than those in protective OLV-VCV（ P 〈 0.05 ） , the lung compliance, the PaO2 and PaCO2 were significantly higher in protective OLV-VCV（ P 〈 0. 05 ）, however,the PaCO2 was within clinical permission range. Conclusion During bilateral pulmonary surgery at the same period,lung protective ventilation strategy （ OLV-PCV and OLV-VCV2 ） can improve the oxygenation of pulmonary alveolus and can effectively reduce the airway peak pressure and the airway resistance, but PVC mode can more effectively reduce airway peak pressure and can relieve airway injury.