摘要
目的评价肺叶支气管填塞通气对食管癌根治术患者肺内分流的影响。方法择期行食管癌根治术患者24例,随机分为2组(n=12):A组为双腔支气管导管组,B组为肺叶支气管填塞气囊组。麻醉诱导后,A组插入双腔支气管导管,B组先插入单腔气管导管,再在纤维支气管镜引导下插入支气管填塞气囊。两组均先行双肺通气30 min,再行肺隔离通气至少30 min,A组为单肺通气,B 组为肺叶支气管填塞通气。术中监测气道压,分别于清醒仰卧位自主呼吸空气时(T0)、侧卧位双肺通气30min(T1)和肺隔离通气30min(T2),抽取桡动脉血和中心静脉血标本,测定血气和血红蛋白,计算肺内分流率(Qs/Qt),采用放免法测定动脉血浆血栓素B2(TXB2)和6-酮-前列腺素F1α(6-k-PGF1α)浓度。结果与A组比较,仅T2时B组PaO2升高,气道压、Qs/Qt及TXB2浓度均降低(P<0．05)。与T0比较,T1时两组Qs/Qt均升高(P<0．05),TXB2浓度变化无统计学意义(P>0．05);与T1比较,T2时A组 Qs/Qt和TXB2浓度升高(P<0．05),而B组变化无统计学意义(P>0．05)。两组6-k-PGF1α浓度组内及组间比较差异均无统计学意义(P>0．05)。结论肺叶支气管填塞通气可以通过降低开胸手术期间的肺内分流来提高机体的氧合功能。
Objective To evaluate the effect of lobe bronchus blockade with a branchial blocker on intrapulmonary shunt during radical esophagus cancer resection. Methods Twenty four ASA Ⅰ -Ⅲ patients with normal lung function aged 18-69 yrs undergoing elective radical esophagus cancer resection were randomized into 2 groups （n = 12 each）： group A one-lung ventilation （OLV） and group B lobe bronchus blockode. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring and blood sampling. Anesthesia was induced with midazolam 50μg·kg^-1, fentanyl 4 μg·kg^-1, propofol 2 mg·kg^-1 and vecurenium 0.1mg·kg^-1. In group A double-lumen tube （DLT） was used while in group B a single lumen endotracheal tube was placed first, then a bronchial blocker was inserted fiberoptically into the bronchus of lower lobe of the operated side. The patients were mechanically ventilated （FiO2 = 100%, Vr = 8 ml·kg^-1 , RR = 10-15 bpm, I： E = 1：2）. PaCO2 was maintained at 30-35 mm Hg. Anesthesia was maintained with 1.5%-2.0% isoflurane and intermittent IV boluses of fentanyl and vecuronium. BP, HR, CVP, SpO2, PErCO2 and airway pressure were monitored during operation. Blood samples were taken simultaneously from radial artery and central vein for blood gas analysis before induction of anesthesia when the patients were lying supine and breathing spontaneously （T0）, after the lungs on both sides were ventilated for 30 rain in lateral position （T1） and 30 rain after OLV （group A） or lower lobe bronchus was blocked off （group B） in lateral position （T2）. Qs/Qt was calculated （blood from central vein was used instead of mixed venous blood from pulmonary artery）. Blood concentrations of TXB2 and 6-k-PGF1 were determined by radioimmunoassay at T0, T1 and T2. Results There was no significant difference in demographic data between the two groups. At T2 the airway pressure in group A was significantly higher than that in group B. At T2 PaO2 was significantly higher in group B than in group A. Qs/Qt was significantly increased at T1 and T2 as compared to the baselines in both groups. Qs/Qt was significantly increased at T2 compared to that at T1 in group A only, while there was no significant difference between Qs/Qt at T1 and T2 in group B. The TXB2 concentration at T2 was significantly increased as compared to that at To and T1 in group A and was significantly higher than that at T2 in group B. Conclusion Lower lobe bronchus blockade was superior to OLV in terms of Qs/Qt and PaO2 during esophagus cancer resection.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第2期130-132,共3页
Chinese Journal of Anesthesiology
关键词
气囊扩张术
肺通气
通气与血流灌注比值
Balloon dilatation
Pulmonary ventilation
Ventilation-perfusion ratio
