【摘要】：目的:通過對(duì)不同單肺通氣模式下患者呼吸生理變化的觀察,為臨床麻醉中選擇合理的保護(hù)性單肺通氣策略提供依據(jù)。方法:選擇擇期行胸腔鏡輔助下胸科手術(shù)患者90例,按不同單肺通氣(OLV)模式隨機(jī)均分為三組。A組行小潮氣量定容通氣模式(VCV):Vt 6 m L/kg,RR 16次/min,PEEP 0 cm H2O;B組行小潮氣量聯(lián)合低呼氣末正壓(PEEP)通氣模式:Vt 6 m L/kg,RR 16次/min,PEEP 5 cm H2O;C組行定壓通氣模式(PCV):壓力設(shè)定為在A組單肺通氣模式下達(dá)穩(wěn)定狀態(tài)時(shí)氣道峰壓,RR 16次/min,PEEP 0 cm H2O。三組分別在OLV前(T0),OLV后30 min(T1)、60 min(T2)、90 min(T3)采集動(dòng)脈血及中心靜脈血行血?dú)夥治?同時(shí)監(jiān)測(cè)該時(shí)點(diǎn)患者的呼吸功能參數(shù),并計(jì)算Qs/Qt和[P(a-et)CO2]。結(jié)果:OLV后各時(shí)點(diǎn),三組患者的Pa O2下降、Qs/Qt增加(P0.05),但B組、C組優(yōu)于A組(P0.05);而三組患者的Ppeak均顯著升高(P0.05),三組之間無明顯差別(P0.05);同時(shí),P(a-et)CO2顯著增大(P0.05)。T1、T2時(shí)點(diǎn)A組的P(a-et)CO2顯著大于B組、C組(P0.05),而T3時(shí)點(diǎn)時(shí)三組間無明顯差別(P0.05);結(jié)論 :行單肺通氣時(shí),采用PCV模式或小潮氣量復(fù)合低PEEP模式是有效的保護(hù)性單肺通氣策略。但隨著單肺時(shí)間延長,仍需及時(shí)進(jìn)行血?dú)夥治?并盡量減少單肺通氣的時(shí)間。
[Abstract]:Objective: to observe the respiratory physiological changes of patients under different one-lung ventilation modes, and to provide the basis for selecting reasonable protective one-lung ventilation strategy in clinical anesthesia. Methods: 90 patients undergoing thoracoscopic surgery were randomly divided into three groups according to different (OLV) modes of one-lung ventilation. Group A received low tidal volume constant volume ventilation mode (VCV): Vt 6 mL kg, RR 16 times / min,PEEP 0 cm H 2O 鈮，

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