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Anesthesiology:不同呼气末正压的单肺通气患者通气血流失衡的生理学评价和呼吸力学机制

2017-12-14 郭唯真 “罂粟花”微信号

由于肺分流和肺不张的发生,单肺通气过程中动脉氧合常常受损。使用低潮气量(VT)(5ml/kg理想体重)的肺保护性通气方法会加剧肺不张。本研究旨在确定单肺通气时呼气末正压和小潮气量通气时的联合生理效应。

背景:由于肺分流和肺不张的发生,单肺通气过程中动脉氧合常常受损。使用低潮气量(VT)(5ml/kg理想体重)的肺保护性通气方法会加剧肺不张。本研究旨在确定单肺通气时呼气末正压和小潮气量通气时的联合生理效应。

方  法:收集41例胸外科全麻病人的资料进行分析。在双肺通气和单肺通气PEEP为0cm H2O时,单肺通气PEEP为5或10cm H2O时测量肺内分流,V/Q和呼吸力学参数。测量吸入氧浓度、呼吸气体浓度和动脉血气计算肺内分流,V/Q。随机选择PEEP的水平,并在测量前维持15分钟。

结  果:在单肺通气过程中,PEEP从0 cm H2O增加到5 cm H2O和10 cm H2O,肺内分流分别下降了5%(0-11)和11%(5-16)(p<0.001)。PaO2/FiO2比值只在呼气末正压10 cm H2O时增加(P<0.001)。在PEEP为10cm H2O时,驱动压力从16±3cm H2O降至PEEP为0cm H2O时的12±3cm H2O(p<0.001)。V/Q值没有变化

结  论:在低潮气量单肺通气时,高呼气末正压水平可改善肺功能且不增加V/Q,同时可降低驱动压力。

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    2017-12-16 huagfeg
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    2017-12-16 skhzy
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