大容量肺灌洗术中精确调节肺通气量的影响
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摘要
目的探讨肺灌洗双肺通气期间精确调节灌洗侧肺通气量的有效性。方法选取120例双肺灌洗患者为研究对象,于第一侧肺灌洗结束双肺通气期间使用容量控制通气模式呼吸管理,潮气量为8~12 ml/kg,随机分成3组,每组40例。第1组不改变左右肺的通气量为不调节组;第2组使用止血钳减少一部分非灌洗侧肺通气的横截面积为粗略调节组;第3组在灌洗侧肺安装监护仪(Philips MP50)呼吸力学监测管,使用阀门(氧气袋流量阀门)逐渐减小非灌洗侧肺的横截面积,通过监护仪监测灌洗侧肺通气量达到预设潮气量的50%,即左右肺通气量相等,每隔5 min重新调节阀门为精确调节组。结果 (1)精确调节组与粗略调节组和不调节组比较,灌洗侧肺的顺应性、血氧饱和度(SPO2)、氧合指数均有提高;心率、平均动脉压等指标在灌洗后20、40、60 min 3个时间点均有下降,差异有统计学意义(P<0.05)。粗略调节组与不调节组比较灌洗侧肺的顺应性提高,平均动脉压指标在灌洗后60 min有下降,差异有统计学意义(P<0.05)。(2)达到第二侧肺灌洗条件时两侧肺灌洗间隔时间,精确调节组与粗略调节组及不调节组比较,粗略调节组与不调节组比较均有缩短,差异有统计学意义(P<0.05)。(3)术后肺不张发生率,不调节组为20.0%,粗略调节组为15.0%,而精确调节组为0;术后肺感染发生率,不调节组为22.5%,粗略调节组为15.0%,而精确调节组为0;差异均有统计学意义(P<0.05)。结论双肺通气期间使用阀门精确调节肺通气量加快了灌洗侧肺顺应性的恢复,缩短了手术时间,减少了术后并发症,是一种行之有效的方法。
[Objective] To investigate the effect of precise regulated ventilation of lavage side lung during double whole-lung lavage.[Methods] A total of 120 patients with double whole-lung lavage were selected as the research object, and were randomly divided into three groups, 40 cases in each group. The volume control ventilation mode was used during the two lung ventilation after the first lung lavaged, with tidal volume of 8-12 ml/kg. The first group did not change the ventilation of two lungs as the nonregulated group. The second group used a hemostatic forceps to reduce the cross-sectional area of the non-lavage side as the rough regulated group. The third group was the precise regulated group, which continuously reduced the cross-sectional area of the nonlavage side using a valve(oxygen bag flow valve), the respiratory monitoring tube(Philips MP50) was used to monitor the lavage side ventilation, and to adjust the valve every 5 minutes when the lavage side ventilation volume approximated the half amount of the presupposition tidal volume, that is, volume of left and right lung ventilation is equal. [ Results ](1) Compared with the rough regulated group and non-regulated group, the compliance, blood oxygen saturation(SPO2) and oxygenation index of lavage side in the precise regulated group increased. The levels of heart rate, mean arterial pressure and other indicators decreased at20, 40, 60 minutes after lavage, and the difference was statistically significant(P<0.05). The compliance of lavage side in rough regulated group was higher than that in the non-regulated group, mean arterial pressure decreased at 60 minutes after lavage,and the difference was statistically significant(P <0.05).(2) The interval time reaching the second lung lavage in the precise regulated group was shortened than that in the rough regulated group and non-regulated group, while that in the rough regulated group was shortened than that in the non-regulated group, and the differences were statistically significant(P <0.05).(3)The incidence rate of atelectasis in the non-regulated group, rough regulated group and precise regulated group was 20.0%,15.0% and 0, respectively. The incidence rate of pulmonary infection in the non-regulated group, rough regulated group and precise regulated group was 22.5%, 15.0% and 0, respectively. The differences were statistically significant(P <0.05).[Conclusion] It is an effective method using the valve to adjust the ventilation accurately during the pulmonary ventilation of double lung lavage, which can improve the compliance recovery, shorten the operation time and reduce the postoperative complications.
[Objective] To investigate the effect of precise regulated ventilation of lavage side lung during double whole-lung lavage.[Methods] A total of 120 patients with double whole-lung lavage were selected as the research object, and were randomly divided into three groups, 40 cases in each group. The volume control ventilation mode was used during the two lung ventilation after the first lung lavaged, with tidal volume of 8-12 ml/kg. The first group did not change the ventilation of two lungs as the nonregulated group. The second group used a hemostatic forceps to reduce the cross-sectional area of the non-lavage side as the rough regulated group. The third group was the precise regulated group, which continuously reduced the cross-sectional area of the nonlavage side using a valve(oxygen bag flow valve), the respiratory monitoring tube(Philips MP50) was used to monitor the lavage side ventilation, and to adjust the valve every 5 minutes when the lavage side ventilation volume approximated the half amount of the presupposition tidal volume, that is, volume of left and right lung ventilation is equal. [ Results ](1) Compared with the rough regulated group and non-regulated group, the compliance, blood oxygen saturation(SPO2) and oxygenation index of lavage side in the precise regulated group increased. The levels of heart rate, mean arterial pressure and other indicators decreased at20, 40, 60 minutes after lavage, and the difference was statistically significant(P<0.05). The compliance of lavage side in rough regulated group was higher than that in the non-regulated group, mean arterial pressure decreased at 60 minutes after lavage,and the difference was statistically significant(P <0.05).(2) The interval time reaching the second lung lavage in the precise regulated group was shortened than that in the rough regulated group and non-regulated group, while that in the rough regulated group was shortened than that in the non-regulated group, and the differences were statistically significant(P <0.05).(3)The incidence rate of atelectasis in the non-regulated group, rough regulated group and precise regulated group was 20.0%,15.0% and 0, respectively. The incidence rate of pulmonary infection in the non-regulated group, rough regulated group and precise regulated group was 22.5%, 15.0% and 0, respectively. The differences were statistically significant(P <0.05).[Conclusion] It is an effective method using the valve to adjust the ventilation accurately during the pulmonary ventilation of double lung lavage, which can improve the compliance recovery, shorten the operation time and reduce the postoperative complications.
引文
[1]陈学信,周洪恩,杨成林.大容量肺灌洗治疗尘肺病155例疗效观察[J].中国煤炭工业医学杂志,2012,15(2):244-246.
[2]孙玉香.大容量全肺灌洗术麻醉恢复期的精细化护理[J].中国煤炭工业医学杂志,2017,20(1):72-76.
[3]陈志远,张志浩,车审言,等.规范的大容量肺灌洗术治疗尘肺病[J].中华医学杂志,2005,85(40):2856-2858.
[4]张振国,陈刚.大容量全肺灌洗术医疗护理常规及操作规程[M].2版.北京:科学技术出版社,2016:51-120
[5]袁扬,黄京慧,陈刚,等.大容量全肺灌洗治疗尘肺病术中肺顺应性的变化[J].工业卫生与职业病,2009,35(5):274-276.
[6]韩志国,马国宣,王继成,等.大容量全肺灌洗治疗尘肺病手术中的麻醉效果[J].中华劳动卫生职业病杂志,2010,28(1):61-62.
[7]韩志国,王继成,袁扬.大容量全肺灌洗术麻醉处理4 147例次报告[J].中国疗养医学,2009,8(7):671.
[8]段建勇.大容量肺灌洗术后肺表面活性物质恢复水平与肺顺应性的关系[J].中华劳动卫生职业病杂志,2014,32(3):223.-225.
[9]蓝岚,古妙宁,欧阳葆怡,等.双侧全肺灌洗对血流动力学和呼吸功能的影响[J].实用临床医学,2012,13(1):42-46.
[10]庄心良,曾因明,陈伯銮.现代麻醉学[M].北京:人民卫生出版社2006:517.
[11]陈刚,马国宣,肖新宇,等.呼吸机在全麻下大容量全肺灌洗术中的应用[J].中华劳动卫生职业病杂志,2010,28(7):539-540.
[12]王继成,马国宣,黄京慧,等.大容量全肺灌洗术中压力调节容量控制通气模式与容量控制通气模式的比较[J].中华劳动卫生职业病杂志,2010,28(2):104-105.
[13]陈刚,马国宣.呼气末正压通气在大容量肺灌洗术中的应用[J].中华劳动卫生职业病杂志,2007,25(10):608-609.|
[14]陈志远,张志浩,车审言,等.大容量全肺灌洗术医疗护理常规及操作规程[M].北京:科学技术出版社,2004:1-17.
[15]张振国,陈刚.大容量全肺灌洗术风险防范及并发症处理[M].北京:人民卫生出版社,2015:78-79.
[2]孙玉香.大容量全肺灌洗术麻醉恢复期的精细化护理[J].中国煤炭工业医学杂志,2017,20(1):72-76.
[3]陈志远,张志浩,车审言,等.规范的大容量肺灌洗术治疗尘肺病[J].中华医学杂志,2005,85(40):2856-2858.
[4]张振国,陈刚.大容量全肺灌洗术医疗护理常规及操作规程[M].2版.北京:科学技术出版社,2016:51-120
[5]袁扬,黄京慧,陈刚,等.大容量全肺灌洗治疗尘肺病术中肺顺应性的变化[J].工业卫生与职业病,2009,35(5):274-276.
[6]韩志国,马国宣,王继成,等.大容量全肺灌洗治疗尘肺病手术中的麻醉效果[J].中华劳动卫生职业病杂志,2010,28(1):61-62.
[7]韩志国,王继成,袁扬.大容量全肺灌洗术麻醉处理4 147例次报告[J].中国疗养医学,2009,8(7):671.
[8]段建勇.大容量肺灌洗术后肺表面活性物质恢复水平与肺顺应性的关系[J].中华劳动卫生职业病杂志,2014,32(3):223.-225.
[9]蓝岚,古妙宁,欧阳葆怡,等.双侧全肺灌洗对血流动力学和呼吸功能的影响[J].实用临床医学,2012,13(1):42-46.
[10]庄心良,曾因明,陈伯銮.现代麻醉学[M].北京:人民卫生出版社2006:517.
[11]陈刚,马国宣,肖新宇,等.呼吸机在全麻下大容量全肺灌洗术中的应用[J].中华劳动卫生职业病杂志,2010,28(7):539-540.
[12]王继成,马国宣,黄京慧,等.大容量全肺灌洗术中压力调节容量控制通气模式与容量控制通气模式的比较[J].中华劳动卫生职业病杂志,2010,28(2):104-105.
[13]陈刚,马国宣.呼气末正压通气在大容量肺灌洗术中的应用[J].中华劳动卫生职业病杂志,2007,25(10):608-609.|
[14]陈志远,张志浩,车审言,等.大容量全肺灌洗术医疗护理常规及操作规程[M].北京:科学技术出版社,2004:1-17.
[15]张振国,陈刚.大容量全肺灌洗术风险防范及并发症处理[M].北京:人民卫生出版社,2015:78-79.