术侧不同通气方式对单肺通气期间肺保护作用的研究进展
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摘要
良好的肺隔离技术是胸科手术顺利进行的保障,单肺通气可导致低氧血症和肺内分流及急性肺损伤。目前,改善低氧血症和肺内分流及急性肺损伤的方法主要有药物应用、麻醉方式、容量治疗和通气模式等方面。对非通气侧肺的研究较少,非通气侧实施持续正压通气或高频喷射通气是胸部手术的一种气道管理策略。该文将对非通气侧行持续正压通气和高频喷射通气两种不同的辅助通气方式对改善肺部并发症的最新研究进展做一综述。
Good lung isolation technology is a guarantee for the smooth operation of thoracic surgery,single lung ventilation can lead to hypoxemia and intrapulmonary shunt and acute lung injury.At present,the methods for improving hypoxemia and intrapulmonary shunt and acute lung injury mainly include drug application,anesthesia,volume therapy and ventilation mode.There are few studies on nonventilated side lungs.Continuous positive pressure ventilation or high frequency jet ventilation on the non-ventilated side is an airway management strategy for thoracic surgery.This article will review the recent advances in the improvement of pulmonary complications in two different assisted ventilation methods,including non-ventilated lateral continuous positive pressure ventilation and high-frequency jet ventilation.
Good lung isolation technology is a guarantee for the smooth operation of thoracic surgery,single lung ventilation can lead to hypoxemia and intrapulmonary shunt and acute lung injury.At present,the methods for improving hypoxemia and intrapulmonary shunt and acute lung injury mainly include drug application,anesthesia,volume therapy and ventilation mode.There are few studies on nonventilated side lungs.Continuous positive pressure ventilation or high frequency jet ventilation on the non-ventilated side is an airway management strategy for thoracic surgery.This article will review the recent advances in the improvement of pulmonary complications in two different assisted ventilation methods,including non-ventilated lateral continuous positive pressure ventilation and high-frequency jet ventilation.
引文
[1]Jin ZB,Wang GY,Chen L,et al.The Causes,Prevention and Treatment of Hypoxemia during One Lung Ventilation for Thoracoscopic Cardiac Surgery[J].Molecular Cardiology of China,2016(2).
[2]Li XQ,Tan WF,Wang J,et al.The effects of thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation:an meta-analysis[J].BMC Anesthesiology,2015,15(1):1-11.
[3]Wilkins MR,Ghofrani HA,Weissmann N,et al.Pathophysiology and treatment of high-altitude pulmonary vascular disease[J].Circulation,2015,131(6):582-590.
[4]Tojo K,Goto T,Kurahashi K.Protective effects of continuous positive airway pressure on a nonventilated lung during onelung ventilation:A prospective laboratory study in rats[J].European Journal of Anaesthesiology,2016,33(10):776.
[5]李钢,李小兵.肺表面活性物质的功能及其在急性肺损伤中的临床应用[J].医学综述,2014,20(13):2320-2322.
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[13]赵晓玲,曾小莉,谢冲,等.不同压力持续气道正压对单肺通气氧化应激反应的影响[J].临床麻醉学杂志,2010,26(11):925-927.
[14]范薇,孙勇,张钧,等.不同压力持续气道正压对单肺通气时患者氧合作用和肺内分流量及内源性抗氧化酶变化的影响[J].临床麻醉学杂志,2015,31(9):880-884.
[15]于美钢,黄钰婷,莫毅洁,等.自制CPAP装置用于单肺通气对动脉氧分压及肺内分流的影响[J].中国临床新医学,2016,9(4):285-288.
[16]张伟,张加强,孟凡民.右美托咪定联合持续气道正压通气对食管癌根治术老年病人单肺通气时肺组织氧化应激反应及炎性反应的影响[J].中华麻醉学杂志,2014,34(1):5-8.
[17]Verhage RJJ,Boone J,Rijkers GT,et al.Reduced local immune response with continuous positive airway pressure during onelung ventilation for oesophagectomy[J].Br J Anaesth,2014,112(5):920-928.
[18]李建钢,沈国灿,葛增才,等.高频喷射通气辅助非通气侧肺通气在单肺叶切除术中的应用[J].昆明医科大学学报,2017(5):116-120.
[19]余鸭全.高频通气在单肺通气手术中的应用分析研究[J].中国现代药物应用,2016,10(18):13-14.
[20]王合梅,张彩娟,雍芳芳,等.术侧肺不同通气方式对开胸手术患者单肺通气时的肺保护效应[J].中华麻醉学杂志,2014(3):300-303.
[2]Li XQ,Tan WF,Wang J,et al.The effects of thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation:an meta-analysis[J].BMC Anesthesiology,2015,15(1):1-11.
[3]Wilkins MR,Ghofrani HA,Weissmann N,et al.Pathophysiology and treatment of high-altitude pulmonary vascular disease[J].Circulation,2015,131(6):582-590.
[4]Tojo K,Goto T,Kurahashi K.Protective effects of continuous positive airway pressure on a nonventilated lung during onelung ventilation:A prospective laboratory study in rats[J].European Journal of Anaesthesiology,2016,33(10):776.
[5]李钢,李小兵.肺表面活性物质的功能及其在急性肺损伤中的临床应用[J].医学综述,2014,20(13):2320-2322.
[6]刘文武,邓立普.肺泡表面活性物质与急性肺损伤[J].蛇志,2013,25(4):412-414.
[7]Della RG,Coccia C.Acute lung injury in thoracic surgery[J].Curr Opin Anaesthesiol,2013,26(1):40-46.
[8]Leite CF,Calixto MC,Toro IF,et al.Characterization of pulmonary and systemic inflammatory responses produced by lung re-expansion after one-lung ventilation[J].J Cardiothorac Vasc Anesth,2012,26(3):427-432.
[9]Lohser J,Slinger P.Lung Injury After One-Lung Ventilation:A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung[J].Anesthesia&Analgesia,2015,121(2):302-318.
[10]García-De-La-Asunción J,García-Del-Olmo E,Perez-Griera J,et al.Oxidative lung injury correlates with one-lung ventilation time during pulmonary lobectomy:a study of exhaled breath condensate and blood[J].European journal of cardio-thoracic surgery:official journal of the European Association for Cardiothoracic Surgery,2015,48(3):37-44.
[11]Erturk E.Ischemia-reperfusion injury and volatile anesthetics[J].Biomed Res Int,2014,2014(6):526301.
[12]Kim YD,Ko S,Kim D,et al.The effects of incremental continuous positive airway pressure on arterial oxygenation and pulmonary shunt during one-lung ventilation[J].Korean Journal of Anesthesiology,2012,62(3):256-259.
[13]赵晓玲,曾小莉,谢冲,等.不同压力持续气道正压对单肺通气氧化应激反应的影响[J].临床麻醉学杂志,2010,26(11):925-927.
[14]范薇,孙勇,张钧,等.不同压力持续气道正压对单肺通气时患者氧合作用和肺内分流量及内源性抗氧化酶变化的影响[J].临床麻醉学杂志,2015,31(9):880-884.
[15]于美钢,黄钰婷,莫毅洁,等.自制CPAP装置用于单肺通气对动脉氧分压及肺内分流的影响[J].中国临床新医学,2016,9(4):285-288.
[16]张伟,张加强,孟凡民.右美托咪定联合持续气道正压通气对食管癌根治术老年病人单肺通气时肺组织氧化应激反应及炎性反应的影响[J].中华麻醉学杂志,2014,34(1):5-8.
[17]Verhage RJJ,Boone J,Rijkers GT,et al.Reduced local immune response with continuous positive airway pressure during onelung ventilation for oesophagectomy[J].Br J Anaesth,2014,112(5):920-928.
[18]李建钢,沈国灿,葛增才,等.高频喷射通气辅助非通气侧肺通气在单肺叶切除术中的应用[J].昆明医科大学学报,2017(5):116-120.
[19]余鸭全.高频通气在单肺通气手术中的应用分析研究[J].中国现代药物应用,2016,10(18):13-14.
[20]王合梅,张彩娟,雍芳芳,等.术侧肺不同通气方式对开胸手术患者单肺通气时的肺保护效应[J].中华麻醉学杂志,2014(3):300-303.