本文選題：正壓呼吸 + 每搏量變異度��； 參考：《中國(guó)全科醫(yī)學(xué)》2017年S1期

【摘要】：目的探究單肺通氣以及單肺通氣聯(lián)合呼氣末正壓(PEEP)對(duì)肺葉切除術(shù)患者每搏量變異度(SVV)的影響,為單肺通氣聯(lián)合PEEP提供麻醉指導(dǎo)依據(jù)。方法選擇2014年3月—2016年3月于浙江大學(xué)金華醫(yī)院行肺葉切除術(shù)的100例患者,對(duì)其病歷資料進(jìn)行回顧性分析,將未聯(lián)合PEEP的50例患者設(shè)為對(duì)照組,聯(lián)合PEEP的50例患者設(shè)為觀察組,觀察時(shí)間點(diǎn)為開始手術(shù)雙肺通氣(T_0)、開始單肺通氣時(shí)(T_1)、單肺通氣10 min(T_2)、單肺通氣30min(T_3)、單肺通氣1 h(T_4)。比較兩組患者手術(shù)指標(biāo)(靜脈滴注總量、機(jī)械通氣時(shí)間、手術(shù)時(shí)間、住院天數(shù))及各時(shí)間點(diǎn)心輸出量(CO)、每搏輸出量(SV)、心指數(shù)(CI)、SVV、平均動(dòng)脈壓(MAP)、心率(HR)、血氧飽和度(SvO_2)、動(dòng)脈血氧分壓(Pa O2)。結(jié)果兩組患者靜脈滴注總量、機(jī)械通氣時(shí)間、手術(shù)時(shí)間、住院天數(shù)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者T_0、T_1、T_2、T_3、T_4CO、SV、CI比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者T_0SVV比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);觀察組患者T_1、T_2、T_3、T_4SVV高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者T_0、T_1、T_2、T_3、T_4MAP、HR、SvO_2比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者T_0PaO_2較T_1、T_2、T_3、T_4 PaO_2高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);觀察組T_1、T_2、T_3、T_4 PaO_2低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論相較于未聯(lián)合PEEP,單肺通氣聯(lián)合PEEP對(duì)CO的影響更小,同時(shí)PaO_2更低、SVV更高,當(dāng)PEEP為7 cm H_2O時(shí)SVV可用于指導(dǎo)液體治療的判斷。
[Abstract]:Objective to investigate the effects of single lung ventilation and positive end-expiratory pressure (PEEP) on SVV in patients undergoing lobectomy, and to provide anaesthesia guidance for monopulmonary ventilation combined with PEEP.Methods 100 patients who underwent lobectomy from March 2014 to March 2016 in Jinhua Hospital of Zhejiang University were selected and their medical records were retrospectively analyzed. 50 patients without PEEP were selected as control group.50 patients with PEEP were divided into observation group. The observed time points were as follows: at the beginning of operation, T0 / T, T 1 / T, 10 min / 10 min / T\ + 2 / T\ + 2, 30 min / min / 30 min / T\ + 3 / T\%, 1 h / h / 1 / h / T\ + 4 / T\ + + / T\ + 1\%\%\%\%\%\%\%\% T\%\%\%?The surgical parameters (total intravenous drip, mechanical ventilation time, operative time) were compared between the two groups.The mean arterial pressure (MAPP), HRT, SvO _ 2, Pao _ 2, Pao _ (2) and Pao ~ (2 +) were measured in each time (P < 0.05) and in each time (P < 0.05). The mean arterial pressure (map) was measured by the mean arterial pressure (map), HRT, oxygen saturation (SvO _ 2), arterial partial pressure of oxygen (Pao _ 2).Results there was no significant difference in the total volume of intravenous drip, the time of mechanical ventilation, the time of operation and the length of hospitalization between the two groups (P 0.05).There was no significant difference in T_0SVV between the two groups (P 0.05), while there was no significant difference in T_0SVV between the two groups (P 0.05), and there was no significant difference between the two groups (P 0.05). The difference between the observation group and the observation group was statistically significant (P 0.05), and that in the observation group was higher than that in the control group.There was no significant difference between the two groups in comparing the number of T0 / T _ 2 and T _ 2T _ (2) / T _ (3) / T _ (4) MAPP / T _ 4 / SvO _ 2 between the two groups. There was no significant difference between the two groups in terms of the number of T_0PaO_2 (P 0.05); the level of T_0PaO_2 in the two groups was higher than that in T _ (1) T _ (2) T _ (2) T _ (3) T _ (3) T _ (4) PaO_2, and the difference was statistically significant (P 0.05) in the observation group (P < 0.05).Conclusion compared with non-PEEP, the effect of one-lung ventilation combined with PEEP on CO is less, and PaO_2 is lower and higher. When PEEP is 7 cm H2O, SVV can be used to guide the judgment of liquid therapy.
【作者單位】： 浙江大學(xué)金華醫(yī)院金華市中心醫(yī)院麻醉科;
【基金】：2014年度金華市科學(xué)技術(shù)研究計(jì)劃項(xiàng)目
【分類號(hào)】：R614

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