不同通气模式在Coopdech封堵管行单肺通气中的比较

目的:通过三种通气模式在支气管封堵管行单肺通气中的应用比较,为临床提供参考.方法:30例患者,随机分为三组.I组采用定容通气;II组采用定压通气;III组采用小潮气量+PEEP.于侧卧位双肺通气10min(T0),侧卧位单肺通气20 min(T1)、40 min(T2)、60 min(T3)四个时间点采集动脉血和混合静脉血,行血气分析并计算肺内分流率(Qs/Qt)和肺动态顺应性(Cldyn).结果:三组患T1、T2、T3时间点各指标与T0时比较有统计学差异,但II组肺动态顺应性降低的幅度比I组和III组小;III组肺内分流率增高幅度比I组和II组小.III组的气道压与I组和II组比较,升高明显较小.结论:在Coopdech封堵管行单肺通气中,在吸气压力设置与定容模式的气道峰压一致时,定压模式改善肺动态顺应性优于定容模式;但定容模式较定压模式肺内分流率升高少,有更好的通气血流比.小潮气量加合适的PEEP,不仅能比定容模式更好地减少肺内分流率,而且能通过降低气道压力和剪力对肺泡造成的损害,在单肺通气时减少对肺的损伤.

comparethe use of different ventilation modes in the Coopdech bronchial occlusion of one-lung ventilation

Objective To comparethe use of different ventilation modes in the Coopdech bronchial occlusion of one- lung ventilation, in order to provide a guidance for the clinical choice of appropriate ventilation mode.Methods Thirty patients were randomly divided into3 group Group I: Volume Control Ventilation (VCV); Group II patients with Pressure Control Ventila-tion (PCV); Group III was treated with low tidal volume VCV with PEEP. Collecting blood gas analysis of both arterial blood and mixed arterial venous blood on four time points.Results On T1, T2, T3 time point there are significant differences when com-paring with T0, the decrease of Cldyn in group II was smaller than that in group I and III; Group III gets a lower increasing range than Group I, II . Between the same time point, Pmean of Group III have a smaller increase than other groups.Conclusion PCV is better on improving Cdyn than VCV; But Qs/Qt are better in VCV, which has a better ventilation flow ratio. Small tidal vol-umewith PEEP, has both advantages and also lowering airway pressure which may damage the aveolars, resulting less damage on the lung during one-lung ventilation.