选择性肺叶隔离对食管癌手术患者肺顺应性和氧合功能的影响

目的观察选择性肺叶隔离技术对左侧剖胸下段食管癌根治术患者肺顺应性及氧合功能的影响。方法 30例择期行下段食管癌根治术患者,随机均分为常规单肺通气对照组(OLV组)和选择性肺叶隔离组(SLB组)。OLV组术中按需行右肺通气,SLB组按需行右肺和左肺上叶通气。分别于侧卧位双肺通气后5 min(T1)、侧卧位右肺或右肺+左肺上叶通气后15 min(T2)、侧卧位右肺或右肺+左肺上叶通气后45 min(T3)、术毕恢复双肺通气后15 min(T4)四个时点记录患者血流动力学指标(CVP、HR、MAP)和呼吸力学指标气道平台压(Pplat)、气道峰压(Ppeak)、肺顺应性(Cdyn)];采集T1^T4时患者颈内静脉和桡动脉血样,进行血气分析,并计算肺内分流率(Qs/Qt)。结果两组患者一般情况、术中血流动力学指标及术野清晰度等比较差异无统计学意义(P>0.05)。两组患者的Pplat、Ppeak在T2、T3时均显著高于T1时,SLB组明显低于OLV组(P<0.05);与T1时比较,两组T2T4时患者颈内静脉和桡动脉血样,进行血气分析,并计算肺内分流率(Qs/Qt)。结果两组患者一般情况、术中血流动力学指标及术野清晰度等比较差异无统计学意义(P>0.05)。两组患者的Pplat、Ppeak在T2、T3时均显著高于T1时,SLB组明显低于OLV组(P<0.05);与T1时比较,两组T2^T4时的Cdyn均降低(P<0.05),SLB组在T2、T3时的Cdyn明显高于OLV组(P<0.05);两组T2、T3时的PaO2均明显低于T1时(P<0.05),但SLB组T2、T3时的PaO2较OLV组高(P<0.05),两组患者在T2、T3时的Qs/Qt均明显升高,同时OLV组T4时仍略高于T1时,而SLB组T2T4时的Cdyn均降低(P<0.05),SLB组在T2、T3时的Cdyn明显高于OLV组(P<0.05);两组T2、T3时的PaO2均明显低于T1时(P<0.05),但SLB组T2、T3时的PaO2较OLV组高(P<0.05),两组患者在T2、T3时的Qs/Qt均明显升高,同时OLV组T4时仍略高于T1时,而SLB组T2^T4时的Qs/Qt均明显低于OLV组(P<0.05)。结论食管癌根治术患者术中行选择性肺叶隔离通气可显著降低Ppeak、Pplat,改善Cdyn,减少肺内分流,增加术中氧合,利于肺保护。

Effects of selective lobar blockade on pulmonary compliance and oxygenation in patients undergoing esophageal surgery

Objective To evaluate the effect of selective lobar blockade （SLB） on pulmonary compliance and oxygenation in patients undergoing esophageal surgery. Methods A total of 30 patients （ASAⅠ-Ⅱ, 48-65 years） scheduled for selective esophageal surgery, were randomly assigned into two groups：patients in one-lung ventilation （OLV） group received right lung ventilation and left lung collapses, patients in SLB group received right lung and superior lobe of left lung ventilation. The hemodynamic parameters, such as CVP, HR, MAP, were recorded at 5 min after two-lung ventilation in lateral position （T1）, 15 min after initiation of OLV or left lower lobar blockade in right lateral position （T2）, 45 min after initiation of OLV or left lower lobar blockade in right lateral position （T3） and 15 min after the chest was closed and switched to two-lung ventilation （T4）, as well as the respiratory mechanics indexes, named Pplat, Ppeak, Cdyn were measured at the time points mentioned above.Moreover, the blood samples were obtained at the time points above from the jugular venous and radial artery for blood gases analysis, and then calculated the right-to-left shunt （Qs/Qt）. Results There was no significant difference of CVP, HR, MAP intergroups or intragroups at T1-4 （P〉0.05）. Meanwhile, there was no difference in the field definition after＆amp;nbsp;thoracotomy and the operation time between the two groups （P〉0.05）. Pplat, Ppeak were all increased at T2, T3 comparing to T1 in the two groups （P〈0.05）, however, which was obviously lower in SLB group comparing to OLV group; Cdyn was decreased at T2-4, and which was higher in SLB group than OLV group at T2, T3;PaO2 were all significantly decreased at T2, T3 comparing to T1 in two groups （P〈0.05）, and which was higher in SLB group than OLV group （P〈0.05）;meanwhile, Qs/Qt was increased at T2, T3 in SLB group, which was increased at T2-4 in OLV group comparing to T1, and it was lower in SLB group at T2-4 comparing to OLV