经胸腔镜肺大泡切除术中应用单肺通气对血气及血液动力学的影响

目的　观察胸腔镜手术中单肺通气时应用不同水平的呼气末正压通气 (PEEP)对血气及血液动力学的影响。方法　随机选择胸腔镜肺大泡切除术病人 36例 ,均分为三组 :A组为单肺间歇正压通气 (IPPV)通气 ;B组为单肺IPPV加PEEP 5cmH2 O通气 ;C组为单肺IPPV加PEEP10cmH2 O通气。分别记录平卧位双肺通气、侧卧位双肺通气、单肺通气 10min和 30min四个时点的血气和血液动力学参数。结果　各组病人SpO2 始终维持在 99%～ 10 0 %。动脉血氧分压 (PaO2 )也在正常范围 ,但B、C组明显高于A组 (P <0 .0 5 )。其余血气指标无明显变化。三组病人HR、MAP、左心室射血时间 (LVET)及体循环血管阻力 (SVR)均无明显变化。B、C组在单肺通气 10min及 30min后 ,每搏量 (SV)及心输出量 (CO)下降明显 ,但均在正常范围 ,且无组间差异。体位改变时血液动力学稳定。结论　经胸腔镜肺大泡切除术中单肺IPPV、PEEP 5cmH2 O均能维持满意的PaO2 和动脉血二氧化碳分压 (PaCO2 ) ,血液动力学变化不显著 ;但PEEP 5cmH2 O较IPPV能进一步提高PaO2 ,PEEP 10cmH2 O不能较PEEP 5cmH2 O进一步提高PaO2 。

Effect of one lung ventilation with PEEP on blood gas and hemodynamics in thoracoscopic surgery

Objective To investigate the effect of one lung ventilation(OLV)on blood gas and hemodynamics in thoracoscopic surgery.Methods 36 patients undergoing thoracoscopic surgery were randomly divided into three groups:IPPV(group A,n=12),IPPV with PEEP 5cmH 2O(group B,n=12) and IPPV with PEEP 10cmH 2O(group C,n=12).Blood gas and hemodynamics were recorded during two-lung ventilation,postural change at OLV 10min and 30min respectively.Results SpO 2 was maintained at 99%-100% in all cases and the blood gas remained normal.PaO 2 of group B and C was significantly higher than that of group A(P<0.05),and there was no difference between group B and C.SV and CO decreased in group B and C.There was no difference in SV and CO between group B and C.The other parameters of three groups did not changed significantly.Postural change had no effect on blood gas and hemodynamics.Conclusions PaO,PaCO 2 and hemodynamics can be kept satisfactory during OLV with IPPV of PEEP 5cmH 2O increases PaO 2 significantly with no apparent changes in hemodynamics.PEEP 10cmH 2O does not increase PaO 2 more than PEEP 5cmH 2O does.