自制CPAP装置用于单肺通气对动脉氧分压及肺内分流的影响

摘要

目的：观察自制持续气道正压通气（CPAP）装置用于单肺通气（OLV）对动脉血氧分压及肺内分流的影响。方法40例择期肺叶切除术患者，ASAⅠ～Ⅱ级，随机分为CPAP组（ A组）和肺萎陷组（ B组），每组20例。 A组单肺通气时在患侧肺使用自制CPAP装置给予5 cmH2 O纯氧持续呼吸道正压通气，B组未予任何干预措施。分别于单肺通气前（ T0）、单肺通气后30 min（ T1）、单肺通气后60 min（ T2）测定动脉及混合静脉血进行血气分析，并根据公式计算肺内分流率（ Qs／Qt）。结果两组T0时点PaO2相比较差异无统计学意义（P＞0.05），T1、T2时点A组的PaO2均较B组高（P＜0.01），而Qs／Qt两组间各时点对比差异均无统计学意义（P＞0.05）。结论单肺通气期间，在患侧肺使用该自制CPAP装置给予5 cmH2O CPAP，可增加动脉血氧分压，但对肺内分流无明显影响。%Objective To investigate the effects of self-made CPAP device on arterial oxygen pressure and intrapulmonary during one-lung ventilation( OLV) .Methods 40 patients with ASA grade ⅠorⅡand a schedule for pulmonary lobectomy surgery and one-lung ventilation were randomly divided into 2 groups:CPAP group( group A, n=20) and matched group(Group B, n=20).In group A, CPAP in 5 cmH2O was administered to the non-ventilated lung by using the self-made device during OLV.Group B did not received any intervention during OLV.Arterial and mixed venous blood samples were taken for gas analysis before OLV ( T1 ) and at 30 min ( T2 ) , 60 min ( T3 ) after OLV.Intrapulmonary shunt( QS/QT ) was calculated.Results There was no significant difference in PO2 between the two groups at T1 ( P>0.05) .PaO2 in group A was higher than that in group B at T2 and T3 ( P<0.01) .Howev-er, there were no significant differences in QS/QT between the two groups at T1, T2 and T3(P>0.05).Conclusion Using the self-made device to add 5 cmH2 O CPAP can effectively improve arterial oxygenation during OLV, but does not affect the intrapulmonary shunt ( Qs/Qt) .