单肺通气联合人工气胸对动脉血—呼气末二氧化碳分压差的影响

发布时间：2019-07-01 19:47

【摘要】：目的观察在单肺通气下实施腔镜食管癌根治术时,建立二氧化碳人工气胸对患者动脉血-呼气末二氧化碳分压差Pa-ETCO2的影响以及Pet CO2和Pa CO2相关性的变化。方法选择43例行腔镜食管癌手术患者,年龄40~60岁,性别不限,体重指数18~25kg/m2,ASA分级I级或者Ⅱ级。先行双肺机械通气。患者改变体位为左侧卧位后开始进行左侧单肺通气。手术开始同时建立二氧化碳人工气胸。胸内操作进行游离食管以及淋巴结清扫等步骤,操作结束后停止人工气胸恢复双肺通气。于插管后双肺通气即刻(T0),单肺通气15min时(T1),单肺通气联合人工气胸后30min时(T2)、60min时(T3)以及停止人工气胸恢复双肺通气后15min时(T4),分别采集桡动脉、中心静脉血标本,进行血气分析,并记录同一时点的Pet CO2、气道峰压(Ppeak)、肺顺应性(Cdyn)。依据血气分析结果计算Pa-ETCO2,Pa-ETCO2/Pa CO2、氧合指数(Pa O2/Fi O2)、肺内分流率(QS/QT),并分析Pet CO2和Pa CO2的相关性。结果与T0比较,本组患者T1时点Pet CO2、Pa CO2、Pa-ETCO2、Pa-ETCO2/Pa CO2、Ppeak、QS/QT升高,氧合指数、Cdyn均有所降低(P均0.05),T2、T3时点变化的趋势更为明显(P均0.05),T4时点上述指标与T0时点比较差异均无统计学意义。双肺通气时二者相关性较好,T0-T2时刻,Pet CO2和Pa CO2均显著相关(P0.01),T3时刻二者的相关系数显著下降(P0.05),恢复双肺通气后,二者相关性也恢复至手术开始之前双肺通气水平(P0.01)。结论单肺通气联合二氧化碳人工气胸后Pa-ET CO2显著增加,Pet CO2和Pa CO2的相关性受到显著影响,单肺通气联合人工气胸停止后各指标均可恢复至术前水平。因此手术过程中应密切监测Pet CO2水平,实时调整机械通气呼吸参数,Pet CO2仍不能完全替代血气分析的临床作用。
[Abstract]:Objective to observe the effect of carbon dioxide artificial pneumothorax on Pa-ETCO2 and the correlation between Pet CO2 and Pa CO2 in patients undergoing endoscopic radical resection of esophageal carcinoma under one-lung ventilation. Methods 43 patients with esophageal cancer underwent endoscopic esophageal cancer surgery, aged 40 卤60 years, regardless of sex, body mass index (BMI) 18 kg / m ~ 2, ASA grade I or II. Mechanical ventilation of both lungs was performed first. The left one-lung ventilation began after the patient changed his position to the left supine position. Carbon dioxide artificial pneumothorax was established at the beginning of the operation. After intrathoracic operation, free esophagus and lymph node cleaning were performed, and artificial pneumothorax was stopped to resume double lung ventilation. Blood samples of radial artery and central vein were collected immediately after intubation (T0), 15min (T1), 30min (T2), 60min (T3) and 15min after stopping pneumothorax. Blood gas analysis was performed, and Pet CO2, peak airway pressure (Ppeak), pulmonary compliance (Cdyn). Was recorded at the same time. According to the results of blood gas analysis, Pa-ETCO2,Pa-ETCO2/Pa CO2, oxygen index (Pa O2/Fi O 2) and pulmonary shunt rate (QS/QT) were calculated, and the correlation between Pet CO2 and Pa CO2 was analyzed. Results compared with T0, Pet CO2,Pa CO2,Pa-ETCO2,Pa-ETCO2/Pa CO2,Ppeak,QS/QT increased, oxygenation index and Cdyn decreased at T1, T2 and T3 were more obvious, but there was no significant difference between T3 and T0 at T2 and T3, but there was no significant difference between T0 and T0 at T1 and T3, but there was no significant difference between T0 and T0 at T1 and T3, but there was no significant difference between T0 and T0 at T1 and T0, but there was no significant difference between T0 and T0. There was a good correlation between the two groups at T0-T2 time, Pet CO2 and Pa CO2 were significantly correlated (P01), and the correlation coefficient at T3 time was significantly decreased (P05). After the recovery of bilateral ventilation, the correlation between them also returned to the level of bilateral ventilation before the beginning of operation (P01). Conclusion Pa-ET CO2 increased significantly after one-lung ventilation combined with carbon dioxide artificial pneumothorax, and the correlation between Pet CO2 and Pa CO2 was significantly affected. All the indexes could be restored to the preoperative level after one-lung ventilation combined with artificial pneumothorax. Therefore, the level of Pet CO2 should be closely monitored and the respiratory parameters of mechanical ventilation should be adjusted in real time. Pet CO2 can not completely replace the clinical effect of blood gas analysis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R614;R735.1

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