發(fā)布時(shí)間：2018-02-02 05:49

  本文關(guān)鍵詞： 允許性高碳酸血癥 胸腔鏡肺切除術(shù) 呼吸參數(shù) 動(dòng)脈血?dú)夥治?血流動(dòng)力學(xué) 嬰兒　出處：《山東醫(yī)藥》2017年31期 　論文類型：期刊論文

【摘要】：目的觀察允許性高碳酸血癥(PHC)通氣策略在嬰兒胸腔鏡肺切除術(shù)中的應(yīng)用效果。方法 64例擇期行胸腔鏡肺切除術(shù)嬰兒隨機(jī)分為觀察組及對照組各32例,觀察組在麻醉過程中采取PHC通氣策略[動(dòng)脈血二氧化碳分壓(PaCO_2)55~80 mmHg],對照組采用傳統(tǒng)通氣策略(PaCO_235~45 mmHg),比較兩組雙肺通氣(TLV)5 min(T_1)、單肺通氣(OLV)30 min(T_2)、OLV 60 min(T_3)、恢復(fù)TLV 60 min(T_4)的呼吸參數(shù)[氣道峰壓(Ppeak)、動(dòng)態(tài)肺順應(yīng)性(Cdyx)]及動(dòng)脈血?dú)夥治鲋笜?biāo)[pH值、PaCO_2、動(dòng)脈血氧分壓(PaO_2)、氧合指數(shù)(OI)、血乳酸(Lac A)、肺內(nèi)分流率(Qs/Qt)]和血流動(dòng)力學(xué)指標(biāo)[平均動(dòng)脈壓(MAP)、心率(HR)]。結(jié)果與對照組比較,觀察組T_2、T_3時(shí)點(diǎn)Ppeak降低,T_2、T_3時(shí)點(diǎn)Cdyx升高(P均0.05);與同組T_1時(shí)點(diǎn)比較,兩組T_2、T_3時(shí)點(diǎn)Ppeak升高,T_2、T_3時(shí)點(diǎn)Cdyx降低(P均0.05)。與對照組比較,觀察組T_2、T_3時(shí)點(diǎn)pH值及Lac A降低,PaCO_2升高(P均0.05);與同組T_1時(shí)點(diǎn)比較,觀察組T_2、T_3時(shí)點(diǎn)pH值、PaO_2、OI、Lac A及對照組PaO_2、OI降低,觀察組PaCO_2、Qs/Qt及對照組Qs/Qt升高(P均0.05)。與對照組比較,觀察組T_2、T_3時(shí)點(diǎn)MAP及HR升高(P均0.05);與同組T_1時(shí)點(diǎn)比較,觀察組T_2、T_3時(shí)點(diǎn)HR升高,對照組T_2、T_3時(shí)點(diǎn)MAP降低(P均0.05)。結(jié)論 PHC通氣策略用于嬰兒胸腔鏡肺切除術(shù)較為安全,其不但可以降低氣道壓,改善肺順應(yīng)性,還能有效改善嬰兒胸腔鏡肺切除術(shù)中OLV時(shí)的氧合。
[Abstract]:Objective to observe PHCs of permissible hypercapnia. Methods 64 infants undergoing thoracoscopic pneumonectomy were randomly divided into observation group (n = 32) and control group (n = 32). PHC ventilation Strategy adopted in the observation Group during Anesthesia. [The arterial blood carbon dioxide partial pressure (Paco) was 55 ~ 80 mmHg, and the control group was treated with traditional ventilation strategy (Paco _ 2 235 ~ 45 mm Hg). The two groups were compared for TLVL / T _ 1 / T _ 1 / T _ 1 / T _ 1 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 3 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 3 respectively. The respiratory parameters of TLV 60 mins. [Peak airway pressure (Ppeaka), dynamic pulmonary compliance (Cdyx) and arterial blood gas analysis. [Paco _ 2, Pao _ 2, oxygen index, lactate acid, intrapulmonary shunt rate Qs / QT] and hemodynamic indexes, Paco _ 2, oxygenation index (Oi), lactate, intrapulmonary shunt rate (Qs / QT)]. [Results compared with the control group, the Ppeak of the observation group was lower than that of the control group. At T _ 3, Cdyx increased by 0.05g / L; Compared with the same group at T _ 1, Ppeak increased at T _ 2T _ 2 / T _ T _ 3 and Cdyx decreased at T _ 2 / T _ 3 in both groups. The pH value and the decrease of Lac A at the time point of T3 and Paco _ 2 increased (P < 0.05); Compared with the same group at T _ 1 time point, the pH value of the observation group T _ 2T _ 2 / T _ T _ 3 and the Pao _ 2O _ I _ Lac _ A of the observation group and the control group decreased, and the PaCO_2 of the observation group were lower than those of the control group. Compared with the control group, the levels of MAP and HR in the observation group were 0.05% at the time point of T _ 2 / T _ 2 and T _ 2 / T _ 2 / T _ 3, respectively. Compared with the same group at T1, the HR of the observation group was higher than that of the control group at the time point T2 / T _ (2) and the control group (T _ (2) / T _ (2)). Conclusion it is safe to use PHC ventilation strategy in thoracoscopic pneumonectomy for infants. It can not only reduce airway pressure and improve lung compliance. It can also improve the oxygenation of OLV during thoracoscopic pneumonectomy in infants.
【作者單位】： 廣東省婦幼保健院;
【基金】：廣東省省級科技計(jì)劃項(xiàng)目(2016A020215127) 廣東省醫(yī)學(xué)科學(xué)技術(shù)研究基金項(xiàng)目(A2016173)
【分類號】：R726.5
【正文快照】： 近年隨著小兒電視胸腔鏡手術(shù)的推廣,單肺通氣(OLV)技術(shù)在小兒胸科手術(shù)中應(yīng)用日益廣泛;它作為一種非生理通氣模式可能導(dǎo)致全身和(或)肺部并發(fā)癥,甚至發(fā)生急性肺損傷[1]。允許性高碳酸血癥(PHC)是一種肺通氣策略,因其可降低由于過高壓力或過大潮氣量等所導(dǎo)致機(jī)械通氣相關(guān)性肺損

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