摘要
目的:观察不同单肺通气模式对胸部手术患者肺氧合功能和血气指标的影响。方法:选取60例接受胸外科手术治疗患者,根据通气方式分为对照组和观察组,每组30例。对照组给予单肺间歇正压通气,观察组采用单肺间歇正压通气加患侧持续正压通气。比较两组患者通气前后血气指标、肺氧合功能、炎性因子水平和并发症发生率的差异。结果:两组患者单肺通气前血气指标动脉血氧分压(PaO_2)和动脉血二氧化碳分压(PaCO_2)比较,差异无统计学意义(t=0.006,t=0.043;P>0.05),单肺通气后30 min和60 min时,观察组患者的PaO_2水平高于对照组,其差异有统计学意义(t=5.383,t=7.938;P<0.001);两组患者单肺通气后30 min和60 min时的PaCO_2水平比较,差异均无统计学意义(t=0.056,t=0.024;P>0.05)。两组患者单肺通气前肺氧合功能差异无统计学意义(t=-0.037,t=-0.062,P>0.05),单肺通气后30 min和60 min时,观察组患者的氧合指数(OI)高于对照组,肺内分流(Os/Qt)水平低于对照组,其差异有统计学意义[OI(t=-10.748,t=-32.678;P<0.001),Os/Qt(t=5.420,t=8.359;P<0.001)]。两组患者通气前炎性因子水平无差异;单肺通气后观察组患者IL-6和hs-CRP水平均低于对照组,其差异有统计学意义(t=12.531,t=7.208;P<0.001);观察组患者术后不适感、肺部感染和术后尿潴留的总发生率低于对照组,其差异有统计学意义(x^2=4.043,P<0.05)。结论:单肺间歇正压通气加患侧持续正压通气对胸部手术患者肺氧合功能和血气指标有较好的改善效果,降低炎性因子水平,具有临床推广应用的价值。
Objective:To observe the effects of different single-lung ventilation modes on pulmonary oxygenation function and blood gas index of patients with thoracic surgery.Methods:60 patients who received thoracic surety were selected as the research subjects.And all of them were divided into control group(n=30 cases)and observation group(n=30 cases)according to different ventilation mode.Patients of control group received intermittent positive pressure ventilation of single-lung,and the patients of observation group received intermittent positive pressure ventilation of single-lung combined with continuous positive pressure ventilation for other affected lung.The differences of blood gas index,pulmonary oxygenation function,inflammatory factor level and the incidence of complications at before and after ventilation between the two groups were compared and analyzed.Results:There were no differences of blood gas indexes(PaO2 and PaCO2)before single lung ventilation between the two groups(t=0.006,t=0.043,P>0.05).At the time of 30min and 60min after one lung ventilation,the PaO2 levels of the observation group were significantly higher than that of the control group(t=5.383,t=7.938,P<0.001),respectively.And the differences of arterial blood PaCO2 between the two groups at the same two time points(30th min and 60th min)were no significant(t=0.056,t=0.024,P>0.05).There were no difference of pulmonary oxygenation function before single-lung ventilation between the two groups(t=-0.037,t=-0.062,P>0.05).And at the time of 30min and 60min after single-lung ventilation,the oxygenation index(OI)of observation group was significantly higher than that of control group and the Os/Qt level of observation group was significantly lower than that of control group[OI(t=-10.748,t=-32.678,P<0.001),Os/Qt(t=5.420,t=8.359,P<0.001)].And the difference of inflammatory factor before ventilation between the two groups was no significant,and the IL-6 and hs-CRP of observation group were significantly lower than that of control group after single-lung ventilation(t=12.531,t=7.208,P<0.001).Besides,the total incidence of postoperative discomfort,pulmonary infection and urinary retention of observation group was significantly lower than that of control group(x^2=4.043,P<0.05).Conclusion:Single lung intermittent positive pressure ventilation combined with continuous positive pressure ventilation for other affected lung has better improvement effect on pulmonary oxygenation function and blood gas index for patients with thoracic surgery,and it can reduce the level of inflammatory factor.Therefore,it has value in clinical popularization and application.
作者
仲华根
田斌斌
冯婷
刘志云
张颖
周子超
ZHONG Hua-gen;TIAN Bin-bin;FENG Ting(Department of Anesthesiology,Taizhou Hospital of Traditional Chinese Medicine,Taizhou 225300,China)
出处
《中国医学装备》
2018年第9期71-74,共4页
China Medical Equipment
关键词
单肺通气
麻醉
氧合
炎性因子
血气
Single lung ventilation
Anesthesia
Oxygenation
Inflammatory factor
Blood gases
