老年患者施行不同通气模式对单肺通气氧合及气道压力的影响

目的观察老年患者胸科手术时单肺通气期间不同通气模式对患者气道压力和氧合的影响。方法需行单肺通气麻醉的老年手术病人120例,其中男性80例,女性40例,年龄60岁以上。将120名患者分为例组,施行全麻诱导双腔插管后行双肺通气,进胸后分别再进行不同通气模式的单肺通气,单肺通气开始后,其中容量控制通气模式(VCV)组(Ⅰ组)VT=10 ml/kg,f=10;压力控制通气模式(PCV)(Ⅱ组)压力设定为达10 ml/kg潮气量的压力值,f=10;VCV组(Ⅲ组)VT=7 ml/kg,f=14;PCV组(Ⅳ组)压力设定为达7 ml/kg潮气量的压力值,f=14;VCV+选择性通气肺呼气末正压组(PEEP)(Ⅴ组)VT=7 ml/kg,f=14,PEEP=5 cm H2O;PCV+PEEP组(Ⅵ组)压力设定为达7 ml/kg潮气量的压力值,f=14,PEEP=5 cm H2O。定时记录数据。结果单肺通气30 min后、单肺通气60 min后,Ⅲ组和Ⅳ组相比氧合具有显著统计学差异(P<0.05),Ⅲ组和Ⅴ组相比氧合具有显著统计学差异(P<0.05),Ⅳ组和Ⅵ组相比氧合具有显著统计学差异(P<0.05)。结论为了改善单肺通气时出现的低氧血症和确保患者在手术中的安全,需要合理选择通气模式,达到提高单肺通气效果的目的,使单肺通气技术得到广泛的推广。

Effect of different ventilation modes on one-lung ventilation, oxygenation and airway pressure in elderly patients

Objective To observe the effect of different ventilation modes on one-lung ventilation,oxygenation and airway pressure during thoracic surgery in elderly patients.Methods One hundred and twenty elderly patients including 80 males and 40 females with age above 60 yr old had been received one-lung ventilation after anesthesia induction,and they were divided into 6 groups to receive double-lumen endobronchial intubation anesthesia,then one-lung ventilation with different ventilation modes was carried out after it enters into chest,and the data were recorded at fixed time points.Results After 30 min and 60 min of one-lung ventilation,there was significant difference in oxygenation between group III and group IV（P 〈 0.05）,and oxygenation between group III and group V（P 〈 0.05） as well as oxygenation between group IV and group VI（P 〈 0.05）.Conclusion In order to improve the hypoxemia during one-lung ventilation and guarantee the security of patients during operation,it should choose proper ventilation mode to enhance the effect of one-lung ventilation and to make the technique of one-lung ventilation for widespread popularization.