不同吸气末停顿及吸呼比对胸科手术单肺通气患者呼吸功能的影响
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摘要
目的探讨需单肺通气(OLV)的胸科手术中不同吸气末停顿(EIP)及吸呼比对患者呼吸功能的影响。方法选择该院择期行胸科手术OLV患者60例,根据随机数字表法将其分为OLV吸呼比1∶2组(A组)和OLV吸呼比1∶1组(B组),每组30例。将两组根据吸气末停顿设置的不同分别随机分为2个亚组,即OLV后吸呼比1∶2,吸气末停顿0%、10%、20%先后通气30 min组(A_1组);吸气末停顿0%、20%、10%先后通气30 min组(A_2组);OLV后吸呼比1∶1,吸气末停顿0%、10%、20%先后通气30 min组(B_1组);吸气末停顿0%、20%、10%先后通气30 min组(B_2组)。每组15例。分别于OLV前(T_1)、OLV后30 min(T_2)、60 min(T_3)、90 min(T_4)记录患者血流动力学指标、呼吸力学指标并采集动脉及中心静脉血进行血气分析。结果在A组与B组中,吸气末停顿20%与吸气末停顿0%、10%比较,患者动脉血二氧化碳分压(Pa CO_2)、死腔率降低(P<0.05)。B组在联合吸气末停顿0%、10%、20%时与A组比较,患者气道压峰值、平台压降低,肺顺应性提高(P<0.05)。结论对胸科手术OLV患者,吸气末停顿20%有利于二氧化碳交换,减少死腔率;吸呼比1∶1可降低气道压,提高肺动态顺应性。两者对患者血流动力学指标无影响。
Objective To investigate the effects of different end-inspiratory pause(EIP)and ratio of inspiration to expiration(I:E)on respiratory function in patients undergoing thoracic surgery with one-lung ventilation(OLV).Methods A total of 60 patients undergoing thoracic surgery with one-lung ventilation in our hospital were randomly divided into two groups:patients receiving I:E of 1:2 group(group A),and patients receiving I:E of 1:1 group(group B)(n=30).Inside each group,patients were randomly divided into 2 subgroups(subgroup A1,A2 and B1,B2)(n=15).Patients in subgroup A1 were ventilated for 30 min with EIP in order of 0%,10%and 20%.Patients in subgroup A2 were ventilated for 30 min with EIP in order of 0%,20%and 10%.Patients in subgroup B1 were ventilated for 30 min with EIP in order of 0%,10%and 20%.Patients in subgroup B2 were ventilated for 30 min with EIP in order of 0%,20%and 10%.Hemodynamics,respiratory parameters and arterial/central venous blood gas were recorded at baseline(T_1),30 min(T_2),60 min(T_3),and 90 min(T_4).Results Patients in both group A and group B with the EIP of 20%experienced downregulated levels of arterial CO_2 partial pressure and the dead space rate compared with that in groups of the EIP as 0%and 10%(P<0.05).P_(peak) and P_(plat) were significantly decreased while pulmonary dynamic compliance was increased in group B when compared with group A(P<0.05).Conclusion For patients undergoing thoracic surgery with one-lung ventilation,EIP of 20%and I:E of 1:1 is more appropriate for CO_2 exchange,reduction of dead space rate and airway pressure and improvement of pulmonary dynamic compliance.
Objective To investigate the effects of different end-inspiratory pause(EIP)and ratio of inspiration to expiration(I:E)on respiratory function in patients undergoing thoracic surgery with one-lung ventilation(OLV).Methods A total of 60 patients undergoing thoracic surgery with one-lung ventilation in our hospital were randomly divided into two groups:patients receiving I:E of 1:2 group(group A),and patients receiving I:E of 1:1 group(group B)(n=30).Inside each group,patients were randomly divided into 2 subgroups(subgroup A1,A2 and B1,B2)(n=15).Patients in subgroup A1 were ventilated for 30 min with EIP in order of 0%,10%and 20%.Patients in subgroup A2 were ventilated for 30 min with EIP in order of 0%,20%and 10%.Patients in subgroup B1 were ventilated for 30 min with EIP in order of 0%,10%and 20%.Patients in subgroup B2 were ventilated for 30 min with EIP in order of 0%,20%and 10%.Hemodynamics,respiratory parameters and arterial/central venous blood gas were recorded at baseline(T_1),30 min(T_2),60 min(T_3),and 90 min(T_4).Results Patients in both group A and group B with the EIP of 20%experienced downregulated levels of arterial CO_2 partial pressure and the dead space rate compared with that in groups of the EIP as 0%and 10%(P<0.05).P_(peak) and P_(plat) were significantly decreased while pulmonary dynamic compliance was increased in group B when compared with group A(P<0.05).Conclusion For patients undergoing thoracic surgery with one-lung ventilation,EIP of 20%and I:E of 1:1 is more appropriate for CO_2 exchange,reduction of dead space rate and airway pressure and improvement of pulmonary dynamic compliance.
引文
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[13]BLANK R S,COLQUHOUN D A,DURIEUX M E,et al.Management of one-lung ventilation:impact of tidal volume on complications after thoracic surgery[J].Anesthesiology:the Journal of the American Society of Anesthesiologists,2016,124(6):1286-1295.
[14]ABOAB J,NIKLASON L,UTTMAN L,et al.CO2 elimination at varying inspiratory pause in acute lung injury[J].Clinical Physiology&Functional Imaging,2007,27(1):2-6.
[15]AGUIRRE-BERMEO H,MORáN I,BOTTIROLI M,et al.End-inspiratory pause prolongation in acute respiratory distress syndrome patients:effects on gas exchange and mechanics[J]. Ann Intensive Care,2016,6(1):81.
[16]KALLET R H,ZHUO H,LIU K D,et al.The association between physiologic dead-space fraction and mortality in patients with the acute respiratory distress syndrome enrolled into a prospective multi-centered clinical trial[J].Respiratory Care,2013,59(11):1611-1618.
[17]KIM S H,CHOI Y S,LEE J G,et al.Efleets of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in the lateral decubitus position[J].Anaesth Intensive Care,2012,40(6):1016-1022.
[18]LEE S M,KIM W H,AHN H J,et al.The effects of prolonged inspiratory time during one-lung ventilation:a randomised controlled trial[J].Anaesthesia,2013,68(9):908-916.
[2]CERPA F,CáCERES D,ROMERODAPUETO C,et al.Humidification on ventilated patients:heated humidifications or heat and moisture exchangers[J].Open Respiratory Medicine Journal,2015,9(Suppl 2):104-111.
[3]DE R E,UTTMAN L,JONSON B.Re-inspiration of CO2 from ventilator circuit:effects of circuit flushing and aspiration of dead space up to high respiratory rate[J].Critical Care,2010,14(2):1-8.
[4]BONI E,CHIARI S,TRIGIANI M,et al.Effect of preceding inspiratory speed and end-inspiratory pause on forced expiratory manoeuvre in healthy subjects and chronic obstructive pulmonary disease patients[J].Respiration,2009,78(3):270-277.
[5]MüLLERREDETZKY H C,FELTEN M,HELLWIG K,et al.Increasing the inspiratory time and I:E ratio during mechanical ventilation aggravates ventilator-induced lung injury in mice[J].Critical Care,2015,19(1):1-11.
[6]DEVAQUET J,JONSON B,NIKLASON L,et al.Effects of inspiratory pause on CO2 elimination and arterial PCO2 in acute lung injury[J].Journal of Applied Physiology,2008,105(6):1944-1949.
[7]ABOAB J,NIKLASON L,UTTMAN L,et al.Dead space and CO2elimination related to pattern of inspiratory gas delivery in ARDS patients[J].Critical Care,2012,16(2):R39.
[8]ASTR?M E,UTTMAN L,NIKLASON L,et al.Pattern of inspiratory gas delivery affects CO2 elimination in health and after acute lung injury[J].Intensive Care Medicine,2008,34(2):377-384.
[9]STURESSON L W,MALMKVIST G,ALLVIN S,et al.An appropriate inspiratory flow pattern can enhance CO2 exchange,facilitating protective ventilation of healthy lungs[J].British Journal of Anaesthesia,2016,117(2):243-249.
[10]MCGRATH B,TENNUCI C,LEE G.The history of one-lung anesthesia and the double-lumen tubes[J].Anesth Hist,2017,3(3):76-86.
[11]SALMAN D,FINNEY S J,GRIFFITHS M J.Strategies to reduce ventilator-associated lung injury(VALI)[J].Burns,2013,39(2):200-211.
[12]KILPATRICK B,SLINGER P.Lung protective strategies in anaesthesia[J].British Journal of Anaesthesia,2010,105(1):108-116.
[13]BLANK R S,COLQUHOUN D A,DURIEUX M E,et al.Management of one-lung ventilation:impact of tidal volume on complications after thoracic surgery[J].Anesthesiology:the Journal of the American Society of Anesthesiologists,2016,124(6):1286-1295.
[14]ABOAB J,NIKLASON L,UTTMAN L,et al.CO2 elimination at varying inspiratory pause in acute lung injury[J].Clinical Physiology&Functional Imaging,2007,27(1):2-6.
[15]AGUIRRE-BERMEO H,MORáN I,BOTTIROLI M,et al.End-inspiratory pause prolongation in acute respiratory distress syndrome patients:effects on gas exchange and mechanics[J]. Ann Intensive Care,2016,6(1):81.
[16]KALLET R H,ZHUO H,LIU K D,et al.The association between physiologic dead-space fraction and mortality in patients with the acute respiratory distress syndrome enrolled into a prospective multi-centered clinical trial[J].Respiratory Care,2013,59(11):1611-1618.
[17]KIM S H,CHOI Y S,LEE J G,et al.Efleets of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in the lateral decubitus position[J].Anaesth Intensive Care,2012,40(6):1016-1022.
[18]LEE S M,KIM W H,AHN H J,et al.The effects of prolonged inspiratory time during one-lung ventilation:a randomised controlled trial[J].Anaesthesia,2013,68(9):908-916.