【摘要】：目的觀察在單肺通氣下實(shí)施腔鏡食管癌根治術(shù)時(shí),建立二氧化碳人工氣胸對(duì)患者動(dòng)脈血-呼氣末二氧化碳分壓差Pa-ETCO2的影響以及Pet CO2和Pa CO2相關(guān)性的變化。方法選擇43例行腔鏡食管癌手術(shù)患者,年齡40~60歲,性別不限,體重指數(shù)18~25kg/m2,ASA分級(jí)I級(jí)或者Ⅱ級(jí)。先行雙肺機(jī)械通氣�；颊吒淖凅w位為左側(cè)臥位后開始進(jìn)行左側(cè)單肺通氣。手術(shù)開始同時(shí)建立二氧化碳人工氣胸。胸內(nèi)操作進(jìn)行游離食管以及淋巴結(jié)清掃等步驟,操作結(jié)束后停止人工氣胸恢復(fù)雙肺通氣。于插管后雙肺通氣即刻(T0),單肺通氣15min時(shí)(T1),單肺通氣聯(lián)合人工氣胸后30min時(shí)(T2)、60min時(shí)(T3)以及停止人工氣胸恢復(fù)雙肺通氣后15min時(shí)(T4),分別采集橈動(dòng)脈、中心靜脈血標(biāo)本,進(jìn)行血?dú)夥治?并記錄同一時(shí)點(diǎn)的Pet CO2、氣道峰壓(Ppeak)、肺順應(yīng)性(Cdyn)。依據(jù)血?dú)夥治鼋Y(jié)果計(jì)算Pa-ETCO2,Pa-ETCO2/Pa CO2、氧合指數(shù)(Pa O2/Fi O2)、肺內(nèi)分流率(QS/QT),并分析Pet CO2和Pa CO2的相關(guān)性。結(jié)果與T0比較,本組患者T1時(shí)點(diǎn)Pet CO2、Pa CO2、Pa-ETCO2、Pa-ETCO2/Pa CO2、Ppeak、QS/QT升高,氧合指數(shù)、Cdyn均有所降低(P均0.05),T2、T3時(shí)點(diǎn)變化的趨勢(shì)更為明顯(P均0.05),T4時(shí)點(diǎn)上述指標(biāo)與T0時(shí)點(diǎn)比較差異均無統(tǒng)計(jì)學(xué)意義。雙肺通氣時(shí)二者相關(guān)性較好,T0-T2時(shí)刻,Pet CO2和Pa CO2均顯著相關(guān)(P0.01),T3時(shí)刻二者的相關(guān)系數(shù)顯著下降(P0.05),恢復(fù)雙肺通氣后,二者相關(guān)性也恢復(fù)至手術(shù)開始之前雙肺通氣水平(P0.01)。結(jié)論單肺通氣聯(lián)合二氧化碳人工氣胸后Pa-ET CO2顯著增加,Pet CO2和Pa CO2的相關(guān)性受到顯著影響,單肺通氣聯(lián)合人工氣胸停止后各指標(biāo)均可恢復(fù)至術(shù)前水平。因此手術(shù)過程中應(yīng)密切監(jiān)測(cè)Pet CO2水平,實(shí)時(shí)調(diào)整機(jī)械通氣呼吸參數(shù),Pet CO2仍不能完全替代血?dú)夥治龅呐R床作用。
[Abstract]:Objective to observe the effect of carbon dioxide artificial pneumothorax on Pa-ETCO2 and the correlation between Pet CO2 and Pa CO2 in patients undergoing endoscopic radical resection of esophageal carcinoma under one-lung ventilation. Methods 43 patients with esophageal cancer underwent endoscopic esophageal cancer surgery, aged 40 鹵60 years, regardless of sex, body mass index (BMI) 18 kg / m ~ 2, ASA grade I or II. Mechanical ventilation of both lungs was performed first. The left one-lung ventilation began after the patient changed his position to the left supine position. Carbon dioxide artificial pneumothorax was established at the beginning of the operation. After intrathoracic operation, free esophagus and lymph node cleaning were performed, and artificial pneumothorax was stopped to resume double lung ventilation. Blood samples of radial artery and central vein were collected immediately after intubation (T0), 15min (T1), 30min (T2), 60min (T3) and 15min after stopping pneumothorax. Blood gas analysis was performed, and Pet CO2, peak airway pressure (Ppeak), pulmonary compliance (Cdyn). Was recorded at the same time. According to the results of blood gas analysis, Pa-ETCO2,Pa-ETCO2/Pa CO2, oxygen index (Pa O2/Fi O 2) and pulmonary shunt rate (QS/QT) were calculated, and the correlation between Pet CO2 and Pa CO2 was analyzed. Results compared with T0, Pet CO2,Pa CO2,Pa-ETCO2,Pa-ETCO2/Pa CO2,Ppeak,QS/QT increased, oxygenation index and Cdyn decreased at T1, T2 and T3 were more obvious, but there was no significant difference between T3 and T0 at T2 and T3, but there was no significant difference between T0 and T0 at T1 and T3, but there was no significant difference between T0 and T0 at T1 and T3, but there was no significant difference between T0 and T0 at T1 and T0, but there was no significant difference between T0 and T0. There was a good correlation between the two groups at T0-T2 time, Pet CO2 and Pa CO2 were significantly correlated (P01), and the correlation coefficient at T3 time was significantly decreased (P05). After the recovery of bilateral ventilation, the correlation between them also returned to the level of bilateral ventilation before the beginning of operation (P01). Conclusion Pa-ET CO2 increased significantly after one-lung ventilation combined with carbon dioxide artificial pneumothorax, and the correlation between Pet CO2 and Pa CO2 was significantly affected. All the indexes could be restored to the preoperative level after one-lung ventilation combined with artificial pneumothorax. Therefore, the level of Pet CO2 should be closely monitored and the respiratory parameters of mechanical ventilation should be adjusted in real time. Pet CO2 can not completely replace the clinical effect of blood gas analysis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R614;R735.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 秦海慶,趙如明,鄒學(xué)超,劉繼;單肺通氣安全時(shí)限的臨床研究[J];上海醫(yī)學(xué);2001年12期

2 劉曉江,高光潔,姚靖,張鐵錚,王鳳學(xué);注射用碳酸酰胺過氧化氫在開胸單肺通氣時(shí)的應(yīng)用[J];臨床麻醉學(xué)雜志;2004年06期

3 沈?qū)?陳中剛,甘小亮,馬武華,黑子清;舒氧康在老年患者單肺通氣手術(shù)中的應(yīng)用體會(huì)[J];廣東醫(yī)學(xué);2005年08期

4 張晉東;楊曉明;張國(guó)榮;任俊清;孫曉東;宋志鴻;范勤;紀(jì)軍;;單腔雙囊氣管導(dǎo)管在小兒?jiǎn)畏瓮饴樽碇械膽?yīng)用[J];臨床麻醉學(xué)雜志;2006年01期

5 黃中華;葉鳳青;李靜;胡彥艷;秦丹丹;張學(xué)剛;;低流量單肺通氣對(duì)體溫影響的觀察[J];現(xiàn)代醫(yī)藥衛(wèi)生;2013年01期

6 鄭澍;李德龍;廖燕凌;陳彥青;;沐舒坦對(duì)單肺通氣患者氧化抗氧化系統(tǒng)相關(guān)指標(biāo)的影響[J];福建醫(yī)藥雜志;2013年04期

7 劉琴湘,鄒冬玲,黃素清;單肺通氣不同時(shí)間對(duì)血?dú)庥绊懙奶接慬J];中國(guó)現(xiàn)代醫(yī)學(xué)雜志;1998年09期

8 張孟元,姚慧;88例全麻下單肺通氣的處理體會(huì)[J];山東醫(yī)藥;1999年20期

9 張秀燕,詹鴻,陳浩文,黃煥娟,陳榮昌;氣管內(nèi)氣體吹入對(duì)單肺通氣效應(yīng)的影響[J];實(shí)用醫(yī)學(xué)雜志;2002年08期

10 李偉,王劍,蔣艷波,許梅曦;烏司他丁對(duì)術(shù)中單肺通氣患者白介素-8的影響[J];癌癥;2003年10期

相關(guān)會(huì)議論文 前10條

1 任利遠(yuǎn);郭建榮;郭偉;;星狀神經(jīng)節(jié)阻滯對(duì)圍術(shù)期單肺通氣缺氧性肺血管收縮的影響[A];2009年浙江省麻醉學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2009年

2 陳潔;鐘泰迪;;單肺通氣技術(shù)研究進(jìn)展[A];第八屆華東六省一市胸心血管外科學(xué)術(shù)會(huì)議論文匯編[C];2005年

3 郭偉;郭建榮;;單肺通氣麻醉的研究現(xiàn)狀[A];2008年第七次華東六省一市麻醉學(xué)學(xué)術(shù)會(huì)議暨浙江省麻醉學(xué)術(shù)年會(huì)論文匯編（上冊(cè)）[C];2008年

4 陶蕾;;長(zhǎng)托寧對(duì)老年患者單肺通氣所致肺損傷的保護(hù)作用[A];全國(guó)第三次麻醉藥理學(xué)術(shù)會(huì)議論文集[C];2012年

5 劉勝?gòu)?qiáng);溫小紅;;單肺通氣的研究進(jìn)展[A];第十二屆華東六省一市麻醉學(xué)術(shù)會(huì)議暨2013年福建省麻醉學(xué)術(shù)會(huì)議論文匯編[C];2013年

6 郭建榮;郭偉;任利遠(yuǎn);金孝\，

本文編號(hào)：2508750