开胸手术前单肺通气体位对血液氧合的影响

摘要

目的 比较开胸手术前单肺通气(OLV)期间不同体位对血液氧合及肺内分流的影响.方法 60例择期开胸食管癌根治术患者,ASAⅡ～Ⅲ级,于开胸前仰卧位双肺通气30 min(T1组,n=20)、仰卧位单肺通气30 min(T2组,n=20)、侧卧位单肺通气30 min(T3组,n=20),分别进行动脉血气分析、静脉血气分析,并计算肺内分流率(Qs/Qt).结果 与T1组比较,T2组动脉血氧分压(PaO2)、混合静脉血氧分压(PvO2)、动脉血氧含量(CaO2)、动脉血氧饱和度(SaO2)、混合静脉血氧饱和度(SvO2)和静脉血氧含量(CvO2)均明显下降,Qs/Qt明显升高(P＜0.05或P＜0.01),T3组PaO2、SaO2明显下降,Qs/Qt明显升高(P＜0.05或P＜0.01),PvO2、SvO2、CaO2和CvO2无明显变化.与T2组比较,T3组PaO2、PvO2、SaO2、SvO2和CvO2明显升高,Qs/Qt明显下降(P＜0.05或P＜0.01).结论 侧卧位单肺通气时血液氧合明显优于仰卧位单肺通气.应尽量减少仰卧位时单肺通气的时间,或避免仰卧位时应用单肺通气.%Objective To compare the effects of position on oxygenation and pulmonary shunt fraction during one lung ven tilation.Methods Sixty patients with ASA Ⅱ- Ⅲ subject to esophagectomy were randomly divided into three groups before chest opening:supine two lung ventilation(TLV) 30 min(T1 group,n = 20),supine one lung ventilation(OLV) 30 min(T2 group,n = 20) ,OLV 30 min in the lateral position(T3 group,n = 20).Arterial and venous blood gas samples were drawn for gas analysis and pulmonary shunt fractions(Qs/Qt) were calculated.Results As compare with T1 group, PaO2 , PvO2 , CaO2 ,SaO2 , SvO2 and CvO2 were significantly decreased, and Qs/Qt significantly increased(P＜0.05 or P＜0.01)in T2 group, PaO2 ,SaO2 significantly decreased and Qs/Qt significantly increased(P＜0.05 or P＜0.01), but PvO2 , SvO2 , CaO2 and CvO2 had no significant change in T3 group.As compared with T2 group, PaO2 , PvO2 , SaO2 , SvO2 and CvO2 were significantly increased,and Qs/Qt significantly decreased in T3 group(P＜0.05 or P＜0.01).Conclusion Blood oxygenation was significantly better and pulmonary shunt fraction was significantly decreased during OLV in lateral position as compared with those in supine position.