摘要
目的对比观察应用Coopdech支气管封堵器与双腔气管导管(DLT)两种单肺通气技术对呼吸道力学及肺内分流率Qs/Qt的影响。方法择期肺叶切除手术患者40例,随机分为Ⅰ、Ⅱ两组,分别应用双腔支气管导管和Coopdech支气管封堵管行单肺通气,观察并记录两组患者呼吸力学参数气道峰压平台压、肺动态顺应性、吸气阻力、呼气阻力,并抽取动脉血和中心静脉血监测PaO2,PvO2,计算肺内分流率。结果与TLV时比较,两组OLV时气道峰压、平台压、吸气阻力、呼气阻力均升高,肺动态顺应性降低(P<0.01);与Ⅱ组比较,Ⅰ组OLV时气道峰压、气道平台压、吸气阻力、呼气阻力升高(P<0.05或0.01),TLV时两组间差异无统计学意义(P>0.05),Ⅱ组Qs/Qt在OLV/TLV时均较Ⅰ组降低(P>0.05),且在Ⅱ组内TLV时较OLV时降低。结论 Coopdech支气管封堵管单肺通气对呼吸道力学参数的影响较DLT小,而较小的气道阻力有利于非通气侧肺血流向通气肺的再分布,从而有利于减轻单肺通气时的肺内分流。
Objective To evaluate the effect of coopdech bronchial blocker and DLT on respiratory mechanics and QS/Qt.Methods fouth ASA Ⅰ~Ⅲ patients aged 35~72ys undergoing pulmonaylobectomy were randomized into two groups：group Ⅰ（DLT）and group Ⅱ（Coopdech）,In group Ⅰ double-lumen dube（DLT）was used while in groupⅡ Coopdech bronchial blocker placed.The patients were mechanicaly ventilated（FiO2=100,Vt=8ml/kg,RR=10~15bpm,I：E=1：2）.Paco2 was maintained at 30~35 mmHg.Pway,Ppeak,Cdgn,Inspiratory resistance,Expiratory resistance,Qs/Qt were monitored during operation.Blood samples were taken simultaneously from radial artery and central vein for blood gas analys.Results Pway,Ppeak,Cdgn,QS/Qt Inspiratory resistance,Expiratory resistance between two groups when OLV was significantly lower than that when TLV.There was no significantly difference in demographic date between the two groups.Qs/Qt in group Ⅱ is lower in OLV/TLV than group I.Conclusion Coopdech bronchial blocker is superior to OLV in terms of QS/Qt and PaO2 during pulmonary lobectomy.
出处
《四川医学》
CAS
2010年第8期1096-1098,共3页
Sichuan Medical Journal
