单肺通气以及单肺通气联合呼气末正压对肺叶切除术患者每搏量变异度的影响研究

发布时间：2018-04-15 16:29

本文选题：正压呼吸 + 每搏量变异度　；参考：《中国全科医学》2017年S1期

【摘要】：目的探究单肺通气以及单肺通气联合呼气末正压(PEEP)对肺叶切除术患者每搏量变异度(SVV)的影响,为单肺通气联合PEEP提供麻醉指导依据。方法选择2014年3月—2016年3月于浙江大学金华医院行肺叶切除术的100例患者,对其病历资料进行回顾性分析,将未联合PEEP的50例患者设为对照组,联合PEEP的50例患者设为观察组,观察时间点为开始手术双肺通气(T_0)、开始单肺通气时(T_1)、单肺通气10 min(T_2)、单肺通气30min(T_3)、单肺通气1 h(T_4)。比较两组患者手术指标(静脉滴注总量、机械通气时间、手术时间、住院天数)及各时间点心输出量(CO)、每搏输出量(SV)、心指数(CI)、SVV、平均动脉压(MAP)、心率(HR)、血氧饱和度(SvO_2)、动脉血氧分压(Pa O2)。结果两组患者静脉滴注总量、机械通气时间、手术时间、住院天数比较,差异无统计学意义(P0.05)。两组患者T_0、T_1、T_2、T_3、T_4CO、SV、CI比较,差异无统计学意义(P0.05);两组患者T_0SVV比较,差异无统计学意义(P0.05);观察组患者T_1、T_2、T_3、T_4SVV高于对照组,差异有统计学意义(P0.05)。两组患者T_0、T_1、T_2、T_3、T_4MAP、HR、SvO_2比较,差异无统计学意义(P0.05);两组患者T_0PaO_2较T_1、T_2、T_3、T_4 PaO_2高,差异有统计学意义(P0.05);观察组T_1、T_2、T_3、T_4 PaO_2低于对照组,差异有统计学意义(P0.05)。结论相较于未联合PEEP,单肺通气联合PEEP对CO的影响更小,同时PaO_2更低、SVV更高,当PEEP为7 cm H_2O时SVV可用于指导液体治疗的判断。
[Abstract]:Objective to investigate the effects of single lung ventilation and positive end-expiratory pressure (PEEP) on SVV in patients undergoing lobectomy, and to provide anaesthesia guidance for monopulmonary ventilation combined with PEEP.Methods 100 patients who underwent lobectomy from March 2014 to March 2016 in Jinhua Hospital of Zhejiang University were selected and their medical records were retrospectively analyzed. 50 patients without PEEP were selected as control group.50 patients with PEEP were divided into observation group. The observed time points were as follows: at the beginning of operation, T0 / T, T 1 / T, 10 min / 10 min / T\ + 2 / T\ + 2, 30 min / min / 30 min / T\ + 3 / T\%, 1 h / h / 1 / h / T\ + 4 / T\ + + / T\ + 1\%\%\%\%\%\%\%\% T\%\%\%?The surgical parameters (total intravenous drip, mechanical ventilation time, operative time) were compared between the two groups.The mean arterial pressure (MAPP), HRT, SvO _ 2, Pao _ 2, Pao _ (2) and Pao ~ (2 +) were measured in each time (P < 0.05) and in each time (P < 0.05). The mean arterial pressure (map) was measured by the mean arterial pressure (map), HRT, oxygen saturation (SvO _ 2), arterial partial pressure of oxygen (Pao _ 2).Results there was no significant difference in the total volume of intravenous drip, the time of mechanical ventilation, the time of operation and the length of hospitalization between the two groups (P 0.05).There was no significant difference in T_0SVV between the two groups (P 0.05), while there was no significant difference in T_0SVV between the two groups (P 0.05), and there was no significant difference between the two groups (P 0.05). The difference between the observation group and the observation group was statistically significant (P 0.05), and that in the observation group was higher than that in the control group.There was no significant difference between the two groups in comparing the number of T0 / T _ 2 and T _ 2T _ (2) / T _ (3) / T _ (4) MAPP / T _ 4 / SvO _ 2 between the two groups. There was no significant difference between the two groups in terms of the number of T_0PaO_2 (P 0.05); the level of T_0PaO_2 in the two groups was higher than that in T _ (1) T _ (2) T _ (2) T _ (3) T _ (3) T _ (4) PaO_2, and the difference was statistically significant (P 0.05) in the observation group (P < 0.05).Conclusion compared with non-PEEP, the effect of one-lung ventilation combined with PEEP on CO is less, and PaO_2 is lower and higher. When PEEP is 7 cm H2O, SVV can be used to guide the judgment of liquid therapy.
【作者单位】：浙江大学金华医院金华市中心医院麻醉科;
【基金】：2014年度金华市科学技术研究计划项目
【分类号】：R614

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