压力控制容量保证通气中不同吸气流速对单肺通气患者呼吸功能的影响*

Effects of on different inspiratory flow rates on respiratory function in patients undergoing one-lung ventilation with pressure controlled and volume guaranteed*

摘要:

目的 探讨在压力控制容量保证通气下不同吸气流速对胸科单肺通气患者呼吸功能的影响。方法 择期行单侧肺病损切除术的单肺通气全身麻醉患者75例。随机分为3组，吸气流速30?L/min组（A组），吸气流速50?L/min组（B组），吸气流速70?L/min组（C组），每组25例。分别于单肺通气前5?min（T0）、单肺通气后30?min（T1）、60?min（T2）、120?min（T3）记录气道峰压（Ppeak）、气道平台压（Pplat）并行血气分析，计算动态肺顺应性（Cdyn）、死腔率（VD/VT）、氧合指数（PaO2/FiO2）和分流率（Qs/Qt）。结果 不同时间点的动脉血 二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、中心静脉血氧饱和度（ScvO2）、Ppeak、Pplat、呼气末正压（PEEP）、VD/VT、Cdyn、PaO2/FiO2、Qs/Qt有差异（P?<0.05）；3组间PaCO2、Ppeak、Pplat、PEEP、VD/VT、Cdyn有差异（P?<0.05）；3组间PaCO2、Ppeak、Pplat、PEEP、VD/VT变化趋势有差异（P?<0.05）。结论 在压力控制容量保证的单肺通气中，适当增加吸气流速可以在降低气道压的同时促使更有效的气体弥散，减少死腔率并改善肺动态顺应性。

Abstract:

Objective To investigate the effects of different inspiratory flow rates on respiratory function in patients undergoing one-lung ventilation (OLV) with pressure controlled and volume guaranteed. Methods A total of 75 patients undergoing unilateral lung lesion resection in general anesthesia with one-lung ventilation were randomly divided into three groups: group A (Insp Flow 30?L/min, n?=?25), group B (Insp Flow 50?L/min, n?=?25) and group C (Insp Flow 70?L/min, n?=?25). Peak airway pressure (Ppeak), plateau airway pressure (Pplat) arterial and central venous blood were collected at 5 minutes before one lung ventilation (T0), 30 minutes (T1), 60 minutes (T2) and 120 minutes (T3) after one lung ventilation, respectively. Then we calculated and analyzed the pulmonary dynamic compliance (Cdyn), dead space rate (VD/VT), PaO2/FiO2 and Qs/Qt. Results Three groups of PaCO2, PaO2, SaO2, ScvO2, Ppeak, Pplat, PEEP, VD/VT, Cdyn, PaO2/FiO2 and Qs/Qt at different time points were significantly different (P?