摘要
目的 比较PEEP改善开胸手术患者定容和定压模式单肺通气（OLV）的效果.方法 择期开胸手术患者50例,性别不限,年龄25 ～ 64岁,体重40 ～ 80 kg,ASA分级Ⅰ-Ⅲ级,采用随机数字表法,将其分为2组（n=25）：容量控制机械通气（VCV）加PEEP组（Ⅴ组）和压力控制机械通气（PCV）加PEEP组（P组）.行OLV时,Ⅴ组VCV 20 min后,加用4cmiH2O PEEP通气20 min,随后去除PEEP;P组采用PCV,处理同Ⅴ组.于开胸前双肺通气即刻（T1）、单肺通气20 min加PEEP前即刻（T2）、加PEEP通气20 min（T3）时,采集动脉血样,行血气分析,并记录气道降压（Ppeak）及OVL开始至T3期间SpO2＜ 95％的发生情况.结果 与P组比较,Ⅴ组T2,3时Ppeak升高,T3时PaO2升高（P＜0.05）；与T1时比较,Ⅴ组和P组T2.3时PaO2降低,Ppeak升高（P＜0.05）；与T2时比较,Ⅴ组和P组T3时SpO2低于95％的发生率降低,PaO2升高（P＜0.05）.结论 4 cm H2O PEEP可改善开胸手术患者定容和定压模式单肺通气的效果,且对定容模式改善效果更好.
Objective To compare volume-controlled ventilation （VCV） versus pressure-controlled ventilation （PCV） improved by PEEP during one-lung ventilation （OLV）.Methods Fifty ASA physical status Ⅰ-Ⅲ patients,aged 25-64 yr,weighing 40-80 kg,undergoing elective thoracotomy,were randomly divided into 2 groups （n =25 each） using a random number table：VCV ＋ PEEP group （group Ⅴ） and PCV ＋ PEEP group （group P）.Those in group Ⅴ underwent OLV initially with VCV for 20 min followed by 4cm H2O PEEP for 20 min and then PEEP was removed.Those in group P underwent OLV initially with PCV for 20 min followed by 4cm H2O PEEP for 20 min and then PEEP was removed.At the beginning of two-lung ventilation before chest opening （T1）,at 20 min of OLV before PEEP （T2）,and at 20 min of ventilation with PEEP （T3）,arterial blood samples were collected for blood gas analysis and the peak airway pressure （Ppeak） and development of SpO2 〈 95 % from beginning of OLV to T3 were recorded.Results Compared with group P,Ppeak at T2,3 and PaO2 at T3 were significantly increased in group Ⅴ （P 〈 0.05）.Compared with the baseline value at T1,PaO2 was significantly decreased and Ppeak was increased at T2.3 in Ⅴ and P groups （P 〈 0.05）.The incidence of SpO2 〈 95% was significantly decreased and PaO2 was increased at T3 than at T2 in Ⅴ and P groups （P 〈 0.05）.Conclusion 4 cm H2O PEEP can improve VCV and PCV during OLV and the improved efficacy is better for VCV in patients undergoing thoracotomy. Keywords：Positive pressure respiration; Pulmonary gas exchange; Respiration, artificial
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第9期1093-1095,共3页
Chinese Journal of Anesthesiology
关键词
正压呼吸
肺换气
呼吸
人工
Positive pressure respiration
Pulmonary gas exchange
Respiration, artificial
