允许性高碳酸血症通气策略在婴儿胸腔镜肺切除术中的应用观察

发布时间：2018-02-02 05:49

本文关键词： 允许性高碳酸血症胸腔镜肺切除术呼吸参数动脉血气分析血流动力学婴儿　出处：《山东医药》2017年31期 　论文类型：期刊论文

【摘要】：目的观察允许性高碳酸血症(PHC)通气策略在婴儿胸腔镜肺切除术中的应用效果。方法 64例择期行胸腔镜肺切除术婴儿随机分为观察组及对照组各32例,观察组在麻醉过程中采取PHC通气策略[动脉血二氧化碳分压(PaCO_2)55~80 mmHg],对照组采用传统通气策略(PaCO_235~45 mmHg),比较两组双肺通气(TLV)5 min(T_1)、单肺通气(OLV)30 min(T_2)、OLV 60 min(T_3)、恢复TLV 60 min(T_4)的呼吸参数[气道峰压(Ppeak)、动态肺顺应性(Cdyx)]及动脉血气分析指标[pH值、PaCO_2、动脉血氧分压(PaO_2)、氧合指数(OI)、血乳酸(Lac A)、肺内分流率(Qs/Qt)]和血流动力学指标[平均动脉压(MAP)、心率(HR)]。结果与对照组比较,观察组T_2、T_3时点Ppeak降低,T_2、T_3时点Cdyx升高(P均0.05);与同组T_1时点比较,两组T_2、T_3时点Ppeak升高,T_2、T_3时点Cdyx降低(P均0.05)。与对照组比较,观察组T_2、T_3时点pH值及Lac A降低,PaCO_2升高(P均0.05);与同组T_1时点比较,观察组T_2、T_3时点pH值、PaO_2、OI、Lac A及对照组PaO_2、OI降低,观察组PaCO_2、Qs/Qt及对照组Qs/Qt升高(P均0.05)。与对照组比较,观察组T_2、T_3时点MAP及HR升高(P均0.05);与同组T_1时点比较,观察组T_2、T_3时点HR升高,对照组T_2、T_3时点MAP降低(P均0.05)。结论 PHC通气策略用于婴儿胸腔镜肺切除术较为安全,其不但可以降低气道压,改善肺顺应性,还能有效改善婴儿胸腔镜肺切除术中OLV时的氧合。
[Abstract]:Objective to observe PHCs of permissible hypercapnia. Methods 64 infants undergoing thoracoscopic pneumonectomy were randomly divided into observation group (n = 32) and control group (n = 32). PHC ventilation Strategy adopted in the observation Group during Anesthesia. [The arterial blood carbon dioxide partial pressure (Paco) was 55 ~ 80 mmHg, and the control group was treated with traditional ventilation strategy (Paco _ 2 235 ~ 45 mm Hg). The two groups were compared for TLVL / T _ 1 / T _ 1 / T _ 1 / T _ 1 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 3 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 3 respectively. The respiratory parameters of TLV 60 mins. [Peak airway pressure (Ppeaka), dynamic pulmonary compliance (Cdyx) and arterial blood gas analysis. [Paco _ 2, Pao _ 2, oxygen index, lactate acid, intrapulmonary shunt rate Qs / QT] and hemodynamic indexes, Paco _ 2, oxygenation index (Oi), lactate, intrapulmonary shunt rate (Qs / QT)]. [Results compared with the control group, the Ppeak of the observation group was lower than that of the control group. At T _ 3, Cdyx increased by 0.05g / L; Compared with the same group at T _ 1, Ppeak increased at T _ 2T _ 2 / T _ T _ 3 and Cdyx decreased at T _ 2 / T _ 3 in both groups. The pH value and the decrease of Lac A at the time point of T3 and Paco _ 2 increased (P < 0.05); Compared with the same group at T _ 1 time point, the pH value of the observation group T _ 2T _ 2 / T _ T _ 3 and the Pao _ 2O _ I _ Lac _ A of the observation group and the control group decreased, and the PaCO_2 of the observation group were lower than those of the control group. Compared with the control group, the levels of MAP and HR in the observation group were 0.05% at the time point of T _ 2 / T _ 2 and T _ 2 / T _ 2 / T _ 3, respectively. Compared with the same group at T1, the HR of the observation group was higher than that of the control group at the time point T2 / T _ (2) and the control group (T _ (2) / T _ (2)). Conclusion it is safe to use PHC ventilation strategy in thoracoscopic pneumonectomy for infants. It can not only reduce airway pressure and improve lung compliance. It can also improve the oxygenation of OLV during thoracoscopic pneumonectomy in infants.
【作者单位】：广东省妇幼保健院;
【基金】：广东省省级科技计划项目(2016A020215127) 广东省医学科学技术研究基金项目(A2016173)
【分类号】：R726.5
【正文快照】： 近年随着小儿电视胸腔镜手术的推广,单肺通气(OLV)技术在小儿胸科手术中应用日益广泛;它作为一种非生理通气模式可能导致全身和(或)肺部并发症,甚至发生急性肺损伤[1]。允许性高碳酸血症(PHC)是一种肺通气策略,因其可降低由于过高压力或过大潮气量等所导致机械通气相关性肺损

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