胸科手术单肺通气期间定容模式和定压模式的比较

目的比较胸科手术单肺通气（OLV）期间采用定容（VCV）和定压（PCV）两种不同通气模式的效果。方法ASAⅠ～Ⅱ级、年龄18～68岁需行单肺通气胸科手术患者24例，随机分为Ⅰ、Ⅱ两组，每组各12例。全身麻醉诱导插双腔管后，侧卧位行双肺定容通气（TLV-VCV）后Ⅰ组先单肺定容通气（OLV—VCV）30min后行单肺定压通气（OLV—PCV），Ⅱ组单肺通气的顺序与Ⅰ组相反，即先定压通气（OLV—PCV）30min再定容通气（OLV—VCV）。双肺定容通气后，每种单肺通气后30min测定并记录心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、脉搏氧饱和度（SpO2）、气道峰压（Ppeak）、平均气道压（Pmean）、潮气量（VT）、呼吸末二氧化碳分压（PETCO2）。同时抽动血测血氧分压、氧饱和度（PaO2、SaO2）及二氧化碳分压（PaCO2）。结果患者TLV-VCV，OLV-VCV与OLV-PCV期间的HR、MAP、CVP、SpO2差异无统计学意义（P〉0．05）；OLV-VCV和OLV-PCV的Ppeak和Pmean较TLV-VCV高（P〈0．05或P〈0．01），而OLV—VCV又比OLV-PCV高（P〈0．05或P〈0．01）；OLV．PCV的PaO2较OLV-VCV高（P〈0．01），三种通气的VT、Sa02、PET，CO2、PaCO2差异无统计学意义（P〉0．05）。结论单肺定压通气效果优于单肺定容通气。

Comparison of volume controlled with pressure comtrolled one-lung ventilation during thoracic surgery

Objective To compare the effects of volume controlled with pressure comtrolled one-lung ventilation during thoracic surgery. Methods Twenty-four ASA Ⅰ～Ⅱ patients ( 18 male ,6 female)aged 18～68 years old undergoing one-lung ventilation (OLV) thoracic surgery were randomly divided into 2 groups ( n = 12 cases). After general anesthesia induction was performed, each patient was inserted a double-lumen tube. Twolung ventilated with volume controlled ventilation (TLV-VCV) was carried out in the lateral decubitus position in all patients. In group Ⅰ, one-lung ventilation was started by volume controlled ventilation (OLV-VCV) for 30 minutes and ventilation mode was then swithched to pressure controlled ventilation (OLV-PCV). Ventilation modes were performed in the opposite order in group Ⅱ, one-lung ventilation was started by pressure controlled ventilation (OLV-PCV) for 30 minutes and ventilation mode was then swithched to volume controlled ventilation (OLV-VCV). The following variables were measured and recorded at the end of TLV-VCV and at 30 minutes of OLV-VCV or OLV-PCV. Heart rate (HR),mean arterial pressure (MAP) and pulse oxygen degree (SpO2) were measured by a same HP monitor. Central venous pressure (CVP) was measured by a special ruler. Tidal volume (VT), peak airway pressure (Ppeak) and mean airway pressure (Pmean) were measured by a same Datex-Ohmeda Aestiva/5 anesthesia machine. End-tide carbon dioxide pressure was measured by a monitor of anesthesia machine. Meantime arterial blood oxygen tsensions and saturations (PaO2, Sat2) and arterial blood carbon dioxide tsensions (PaCO2) were analysed by arterial venous blood gases. Results There were no significant differences in HR, MAP, CVP and SpO2 between TLV-VCV, OLV-VCV and OLV-VCV (P>0. 05). Ppeak and Pmean were significant higher during OLV-VCV or OLV-PCV than during TLV-VCV (P < 0.05 or P < 0. 01) ,but these were higher during OLV-VCV than during OLV-PCV (P <0. 05 or P <0. 01). PaO2 was higher during OLV-PCV than during OLV-VCV (P < 0. 05). There were no significant difference in VT, SaO2, PET CO2, PaCO2 between OLV-VCV and OLV-PCV (P>0.05). Conclusion The effects of OLV-PCV was superior to OLV-VCV during thoracic surgery.