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目的观察胸腹腔镜下食管癌根治术患者单肺通气(one lung ventilation,OLV)时非通气侧肺持续气道正压(continuous positive airway pressure,CPAP)通气对肺内分流和氧合的影响。方法 80例择期行胸腹腔镜下食管癌根治术患者,ASA分级Ⅰ～Ⅱ级,采用随机数字表法分为4组(n=20):对照组(单肺通气时非通气侧支气管导管与大气相通)及CPAP 2 cmH2O组、CPAP 5 cmH2O组、CPAP 8 cmH2O组(单肺通气时非通气侧肺分别给予2、5、8 cmH2O的CPAP处理)。分别于单肺通气前(T1)、单肺通气30 min(T2)、60 min(T3)、90 min(T4)、120 min(T5)采血行血气分析,根据公式计算肺内分流率(Qs/Qt)。结果对照组和CPAP2 cmH2O组T2～T5各时点Qs/Qt较T1明显增高,动脉血氧分压[p(O2)]明显降低(P<0.05);CPAP5 cmH2O组和CPAP8 cmH2O组T2～T5各时点Qs/Qt较T1亦有增加,p(O2)亦有降低,但差异无显著性(P>0.05);T2～T5各时点,CPAP 5 cmH2O组、CPAP 8 cmH2O组Qs/Qt明显低于对照组和CPAP 2 cmH2O组,p(O2)明显高于对照组和CPAP 2 cmH2O组(P<0.05),而CPAP 5 cmH2O组与CPAP 8 cmH2O组在上述各时点Qs/Qt、p(O2)无统计学差异(P>0.05)。胸外科医师对对照组、CPAP 2 cmH2O组、CPAP 5 cmH2O组手术侧肺萎陷满意度优于CPAP 8 cmH2O组,各组手术时间无差异(P>0.05)。结论胸腹腔镜下食管癌根治术患者单肺通气时对非通气侧肺实施5 cmH2O和8 cmH2O的CPAP可减少肺内分流,明显提高p(O2),防止低氧血症的发生;5 cmH2O的CPAP有利于术野暴露,满足手术操作。
Objective To observe the effects of continuous positive airway pressure (CPAP) ventilation on lung shunt and oxygenation during laparoscopic laparoscopic radical mastectomy for one lung ventilation (OLV). Methods Eighty patients undergoing thoracoscopic and laparoscopic esophageal cancer radical resection were randomly divided into 4 groups (n = 20): ASA grade Ⅰ ~ Ⅱ, control group (n = Atmosphere), CPAP 2 cmH2O group, CPAP 5 cmH2O group and CPAP 8 cmH2O group (CPAP treatment with non-ventilated lungs of 2, 5 and 8 cmH2O respectively). Blood samples were collected for blood gas analysis before single lung ventilation (T1), single lung ventilation for 30 min (T2), 60 min (T3), 90 min (T4) and 120 min (T5) / Qt). Results Compared with T1, the Qs / Qt of T2 ~ T5 in control group and CPAP2 cmH2O group were significantly higher than those in T1 group (P <0.05); the levels of T2 ~ T5 in CPAP5 cmH2O group and CPAP8 cmH2O group Qs / Qt at each time point also increased compared with T1, and p (O2) also decreased, but there was no significant difference (P> 0.05). At each time point of T2 ~ T5, Qs / Qt of CPAP 5 cmH2O group and CPAP 8 cmH2O group (P <0.05). However, the values of Qs / Qt, Qt, Qt and Qt in the CPAP 5 cmH2O group and the CPAP 8 cmH2O group were significantly lower than those in the control and CPAP 2 cmH2O groups There was no significant difference in p (O2) (P> 0.05). Thoracic surgeons were more satisfied with CPAP 8 cmH2O than control group in CPAP 2 cmH2O group and CPAP 5 cmH2O group. There was no significant difference in operative time between the two groups (P> 0.05). Conclusions CPAP with 5 cmH2O and 8 cmH2O for non-ventilated lungs during lung laparoscopic radical mastectomy for esophageal cancer can reduce intrapulmonary shunt, significantly increase p (O2) and prevent hypoxemia when single lung ventilation is performed. The incidence of hypoxemia is 5 cmH2O CPAP is conducive to surgical field exposure, to meet the surgical operation.