不同吸气末停顿及吸呼比对胸科手术 单肺通气患者呼吸功能的影响

Effect of different end-inspiratory pause and ratio of inspiration to expiration on respiratory function in patients undergoing thoracic surgery with one-lung ventilation

摘要:

目的 探讨需单肺通气（OLV）的胸科手术中不同吸气末停顿（EIP）及吸呼比对患者呼吸功能的 影响。方法 选择该院择期行胸科手术OLV 患者60 例，根据随机数字表法将其分为OLV 吸呼比1 ∶ 2 组（A 组） 和OLV 吸呼比1 ∶ 1 组（B 组），每组30 例。将两组根据吸气末停顿设置的不同分别随机分为2 个亚组，即 OLV 后吸呼比1 ∶ 2，吸气末停顿0%、10%、20% 先后通气30 min 组（A1 组）；吸气末停顿0%、20%、10% 先后通气30 min 组（A2 组）；OLV 后吸呼比1 ∶ 1，吸气末停顿0%、10%、20% 先后通气30 min 组（B1 组）； 吸气末停顿0%、20%、10% 先后通气30 min 组（B2 组）。每组15 例。分别于OLV 前（T1）、OLV 后30 min（T2）、 60 min（T3）、90 min（T4）记录患者血流动力学指标、呼吸力学指标并采集动脉及中心静脉血进行血气分析。 结果 在A 组与B 组中，吸气末停顿20% 与吸气末停顿0%、10% 比较，患者动脉血二氧化碳分压（PaCO2）、死 腔率降低（P <0.05）。B 组在联合吸气末停顿0%、10%、20% 时与A 组比较，患者气道压峰值、平台压降低，肺顺 应性提高（P <0.05）。结论 对胸科手术OLV 患者，吸气末停顿20% 有利于二氧化碳交换，减少死腔率；吸 呼比1 ∶ 1 可降低气道压，提高肺动态顺应性。两者对患者血流动力学指标无影响。

Abstract:

Objective To investigate the effects of different end-inspiratory pause (EIP) and ratio of inspiration to expiration (I: E) on respiratory function in patients undergoing thoracic surgery with one-lung ventilation (OLV). Methods A total of 60 patients undergoing thoracic surgery with one-lung ventilation in our hospital were randomly divided into two groups:patients receiving I : E of 1 : 2 group (group A), and patients receiving I : E of 1 : 1 group (group B) (n = 30). Inside each group, patients were randomly divided into 2 subgroups (subgroup A1, A2 and B1, B2) (n = 15). Patients in subgroup A1 were ventilated for 30 min with EIP in order of 0%, 10% and 20%. Patients in subgroup A2 were ventilated for 30 min with EIP in order of 0%, 20% and 10%. Patients in subgroup B1 were ventilated for 30 min with EIP in order of 0%, 10% and 20%. Patients in subgroup B2 were ventilated for 30 min with EIP in order of 0%, 20% and 10%. Hemodynamics, respiratory parameters and arterial/central venous blood gas were recorded at baseline (T1), 30 min (T2), 60 min (T3), and 90 min (T4). Results Patients in both group A and group B with the EIP of 20% experienced downregulated levels of arterial CO2 partial pressure and the dead space rate compared with that in groups of the EIP as 0% and 10% (P < 0.05). Ppeak and Pplat were significantly decreased while pulmonary dynamic compliance was increased in group B when compared with group A (P < 0.05). Conclusion For patients undergoing thoracic surgery with one-lung ventilation, EIP of 20% and I : E of 1 : 1 is more appropriate for CO2 exchange, reduction of dead space rate and airway pressure and improvement of pulmonary dynamic compliance.