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| 单肺通气期间不同吸入氧浓度对术中呼吸功能的影响 |
| Effects of different inspired oxygen fraction during one-lung ventilation on intraoperative respiratory function |
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| DOI：10.12089/jca.2022.06.004 |
| 中文关键词: 吸入氧浓度 单肺通气 肺内分流 氧合 |
| 英文关键词: Inspired oxygen fraction One-lung ventilation Intrapulmonary shunt Oxygenation |
| 基金项目:河北省卫生健康委医学科学研究课题计划（20160305） |
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| 中文摘要: |
目的 探讨单肺通气（OLV）期间不同吸入氧浓度（FiO2）对胸外科手术患者呼吸功能的影响。
方法 选择2020年11月至2021年8月择期行肺叶切除术的患者57例，男40例，女17例，年龄18～64岁，BMI 18～28 kg/m2，ASA Ⅰ或Ⅱ级。将患者随机分为三组：FiO2 45%组（L组）、FiO2 65%组（M组）和FiO285%组（H组），每组19例。三组分别在OLV期间予以对应的FiO2。记录术前肺通气功能检查指标，包括用力肺活量（FVC）、第1秒用力呼气量（FEV1）、1秒率（FEV1/FVC）、分钟最大通气量占预计值百分比（MVV%）。于OLV前5 min、OLV后10、20、30、60 min分别经桡动脉与右颈内静脉抽取动静脉血行血气分析，记录SaO2、PaO2、PaCO2、Hb、Lac，并计算氧合指数（PaO2/FiO2）、肺内分流率（Qs/Qt）、死腔率（VD/VT），记录以上各时点肺动态顺应性（Cdyn）、气道峰压（Ppeak）、HR和MAP。
结果 三组术前FVC、FEV1、FEV1/FVC、MVV%差异无统计学意义。OLV后10、20、30 min M组和H组PaO2明显高于L组（P＜0.05）。OLV后10、20、30、60 min M组和H组PaO2/FiO2、Cdyn明显低于L组（P＜0.05）；H组PaO2/FiO2、Cdyn明显低于M组（P＜0.05），Qs/Qt、Ppeak明显高于L组和M组（P＜0.05）。OLV后60 min M组Qs/Qt明显高于L组（P＜0.05），H组PaO2明显高于L组（P＜0.05）。OLV前5 min、OLV后10、20、30、60 min三组SaO2、PaCO2、Hb、Lac、HR、MAP差异无统计学意义。
结论 OLV期间使用FiO2 45%和FiO2 65%均可以减少肺内分流，提高肺顺应性，改善氧合。 |
| 英文摘要: |
Objective To investigate the effect of different inspired oxygen fraction during one-lung ventilation (OLV) on respiratory function in patients undergoing thoracic surgery.
Methods Fifty-seven patients, 40 males and 17 females, aged 18-64 years, BMI 18-28 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled for lobectomy from November 2020 to August 2021 were selected. All the patients were randomly divided into three groups: FiO2 45% group (group L), FiO2 65% group (group M), and FiO2 85% group (group H), 19 patients in each group. Corresponding FiO2 was given to the three groups during OLV. Forced vital capacity (FVC), forced expirtory volume in the first second (FEV1), FEV1/FVC, percentage of the maximum ventilation per minute to the estimated value (MVV%) were recorded before the operation. Arterial and venous blood samples were taken from transradial artery and right internal jugular vein 5 minutes before OLV, 10, 20, 30, and 60 minutes after OLV for blood gas analysis, SaO2, PaO2, PaCO2, Hb, and Lac were recorded at each time point; and oxygenation index (PaO2/FiO2 ), intrapulmonary shunt rate (Qs/Qt), and dead space rate (VD/VT) were calculated at each time point. Pulmonary dynamic compliance (Cdyn), peak airway pressure (Ppeak), HR, and MAP were recorded at each time point.
Results There were no significant differences in preoperative FVC, FEV1, FEV1/FVC, and MVV% pred among the three groups. Compared with group L, PaO2 in groups M and H were significantly increased 10, 20, and 30 minutes after OLV (P < 0.05), PaO2/FiO2 and Cdyn in groups M and H were significantly decreased 10, 20, 30, and 60 minutes after OLV (P < 0.05), Qs/Qt and Ppeak in group H were significantly increased 10, 20, 30, and 60 minutes after OLV (P < 0.05), Qs/Qt in group M and PaO2 in group H were significantly increased 60 minutes after OLV (P < 0.05). Compared with group M, PaO2/FiO2 and Cdyn were significantly decreased, Qs/Qt and Ppeak were significantly increased in group H 10, 20, 30, and 60 minutes after OLV (P < 0.05). There were no significant differences in SaO2, PaCO2, Hb, Lac, HR, and MAP among the three groups 5 minutes before OLV and 10, 20, 30, and 60 minutes after OLV.
Conclusion The use of FiO2 45% and FiO2 65% during OLV can reduce intrapulmonary shunt, increase lung compliance, and improve oxygenation. |
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