[1]李琪英,闵苏.持续气道正压通气对胸腹腔镜下食管癌根治术患者单肺通气时肺内分流和氧合的影响[J].第三军医大学学报,2011,33(10):1065-1067.
 Li Qiying,Min Su.Effects of continuous positive airway pressure on oxygenation and shunt fraction during one-lung ventilation in thoracoscopy and laparoscopy-assisted radical treatment of esophageal carcinoma[J].J Third Mil Med Univ,2011,33(10):1065-1067.
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持续气道正压通气对胸腹腔镜下食管癌根治术患者单肺通气时肺内分流和氧合的影响(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
33卷
期数:
2011年第10期
页码:
1065-1067
栏目:
论著
出版日期:
2011-05-30

文章信息/Info

Title:
Effects of continuous positive airway pressure on oxygenation and shunt fraction during one-lung ventilation in thoracoscopy and laparoscopy-assisted radical treatment of esophageal carcinoma
作者:
李琪英闵苏
重庆医科大学附属第一医院麻醉科
Author(s):
Li Qiying Min Su
Department of Anesthesiology, First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China
关键词:
持续气道正压通气胸腔镜腹腔镜食管癌
Keywords:
continuous positive airway pressure thoracoscopy laparoscopy esophageal carcinoma one-lung ventilation
分类号:
R332;R655;R735.1
文献标志码:
A
摘要:
目的    观察胸腹腔镜下食管癌根治术患者单肺通气(one lung ventilation,OLV)时非通气侧肺持续气道正压(continuous positive airway pressure,CPAP)通气对肺内分流和氧合的影响。    方法    80例择期行胸腹腔镜下食管癌根治术患者,ASA分级Ⅰ~Ⅱ级,采用随机数字表法分为4组(n=20):对照组(单肺通气时非通气侧支气管导管与大气相通)及CPAP 2 cmH2O组、CPAP 5 cmH2O组、CPAP 8 cmH2O组(单肺通气时非通气侧肺分别给予2、5、8 cmH2O的CPAP处理)。分别于单肺通气前(T1)、单肺通气30 min(T2)、60 min(T3)、90 min(T4)、120 min(T5)采血行血气分析,根据公式计算肺内分流率(Qs/Qt)。    结果    对照组和CPAP 2 cmH2O组T2~T5各时点Qs/Qt较T1明显增高,动脉血氧分压[p(O2)]明显降低 ( P<0.05);CPAP 5 cmH2O组和CPAP 8 cmH2O组T2~T5各时点Qs/Qt较T1亦有增加,p(O2)亦有降低,但差异无显著性(P>0.05);T2~T5各时点,CPAP 5 cmH2O组、CPAP 8 cmH2O组Qs/Qt明显低于对照组和CPAP 2 cmH2O组,p(O2)明显高于对照组和CPAP 2 cmH2O组( P<0.05),而 CPAP 5 cmH2O组与CPAP 8 cmH2O组在上述各时点Qs/Qt、p(O2)无统计学差异(P>0.05)。胸外科医师对对照组、CPAP 2 cmH2O组、CPAP 5 cmH2O组手术侧肺萎陷满意度优于CPAP 8 cmH2O组,各组手术时间无差异(P>0.05)。    结论    胸腹腔镜下食管癌根治术患者单肺通气时对非通气侧肺实施5 cmH2O和8 cmH2O的CPAP可减少肺内分流,明显提高p(O2),防止低氧血症的发生;5 cmH2O的CPAP有利于术野暴露,满足手术操作。
Abstract:
Objective    To evaluate the effects of continuous positive airway pressure (CPAP) for non-ventilated lung on the intrapulmonary shunt fraction and oxygenation during one-lung ventilation (OLV) in patients who received thoracoscopy and laparoscopy-assisted radical treatment of esophageal carcinoma.     Methods    Eighty ASA class Ⅰ-Ⅱ esophageal carcinoma patients scheduled for esophagectomy under thoracoscopy and laparoscopy were enrolled and randomly divided into 4 groups (n=20): a control group, a CPAP 2 cmH2O group, a CPAP 5 cmH2O group, and a CPAP 8 cmH2O group. The patients in control group had non-ventilated lungs connected with the air during OLV, while those in CPAP groups had 2, 5, and 8 cmH2O CPAP for the non-ventilated lungs respectively. Blood gases of all patients were analyzed separately before OLV (T1) and 30 min (T2), 60 min (T3), 90 min (T4), and 120 min (T5) after OLV to calculate intrapulmonary shunt (Qs/Qt).     Results    PaO2 decreased and Qs/Qt increased significantly at T2-T5 time points in the control group and CPAP 2 cmH2O group, compared with those at T1 time point (P<0.05). There was no significant difference in PaO2 and Qs/Qt between T1 and T2-T5 time points in the CPAP 5 cmH2O group and CPAP 8 cmH2O group (P>0.05). PaO2 was higher and Qs/Qt was lower at T2-T5 time points in the CPAP 5 cmH2O group and CPAP 8 cmH2O group than those in the control group and CPAP 2 cmH2O group (P<0.05). There was no significant difference in PaO2 and Qs/Qt at T2-T5 time points between the CPAP 5 cmH2O group and CPAP 8 cmH2O group (P>0.05). The CPAP 8 cmH2O group had less satisfactory lung collapse than other groups. There was no significant difference among the 4 groups in average operative time (P>0.05).     Conclusion    CPAP at 5 or 8 cmH2O for non-ventilated lungs during OLV in patients who receive thoracoscopy and laparoscopy-assisted radical treatment of esophageal carcinoma can reduce intrapulmonary shunt, increase PaO2 and prevent hypoxemia. Compared with 8 cmH2O CPAP, 5 cmH2O CPAP can provide a better surgical field for operation.

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更新日期/Last Update: 2011-05-12