超前肺复张策略提高开胸单肺通气期间的氧合

目的探究超前肺复张策略提高开胸单肺通气期间的氧合。方法40例择期肺叶切除左支气管插管患者，随机分成两组，超前肺复张（PARS）组单肺通气（OLV）前先给累计10次使气道峰压缓慢达到40cm H2O的手工通气，对照组（C组）不采用PARS策略。记录OLV后15、30、45、60min及OLV结束前的平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、动脉氧分压（PaO2），计算肺胸的动态与静态顺应性。结果PARS组较C组PaO2均有增加，尤以OLV 15min及OLV结束差异显著（P〈0．01），另外A—aDO2减少，尤以OLV 15min及OLV结束时有显著差异（P〈0．01）。结论OLV前PARS加PEEP策略提高单肺通气期间的氧合。

A preemptive alveolar recruitment strategy improves arterial oxygenation during one lung ventilation

Objective To evaluate the effect whether a preemptive of alveolar recruitment strategy(PARS) before one-lung ventilation(OLV) improves arterial oxygenation during OLV in patients undergoing thoracic surgey.Methods Forty patients undergoing elective thoracic surgery.After inducion of anaesthesia,a left-side Mallinckrodt double-lumen tube was inserted,and its final position was comfirmed using a fibreoptic bronchoscope in the lateral position.After double lung ventilation five minutes,arterial blood sample was obtained through the radial catheter as base data.Then the patients were randomLy divided into PARS and C groups.PARS group(n = 20) consisted two thechniques:First 10 manul breaths with a peak inspiratory pressure of 40 cm H2O were performed and subsequently PEEP 5 cm H2O was applied to both lungs in volume control mode.Those in group C(n = 20)received no ARS,but applied 5 cm H2O PEEP afer the lateral position.During OLV,recorded:mean arterial pressure(MAP),central venous pressure(CVP),heart rate(HR),alveolar-arterial oxygen tension(PaO2)and dynamic and static compliances difference after 15,30,45,60 min of OLV,and at the end of OLV.Results PaO2 was signficantly higer in group PARS than in group C after 15 min of OLV and the end of OLV(P < 0.01).The alverolar-arterial oxygen tension difference(A-aDO2)was significantly lower in group PARS than in group C afer 15 min of OLV and at the end of OLV(P < 0.01).Conclusion A preemptive alveolar recruitment strategy before one-lung ventilation improves arterial oxygenation during one lung ventilation