支气管封堵器对老年患者呼吸参数的影响

摘要

Objective To discuss the influence of DLT and bronchus occluder in single lung ventilation on respiratory mechanics parameters of elderly patients.Methods 60 elderly patients received lobectomy from Septem-ber 2013 to April 2015 were randomly divided into two groups.The control group was given DLT,and the observation group was given bronchial occluder single lung ventilation.Their respiratory mechanics parameters and intrapulmonary shunt were recorded and analyzed.Results After single lung ventilation,their inspiratory resistance,expiratory re-sistance,peak airway pressure and inspiratory plateau pressure increased significantly,and lung dynamic compliance decreased obviously in the two groups (P <0.05),but the difference was more pronounced in the observation group than in the control group (P <0.05 or P <0.01).After anesthesia,the levels of PaO2 ,PvO2 and Qs/Qt increased significantly in the two groups (P <0.05).Compared with one-lung ventilation,there were significant difference in PaO2 and Qs/Qt for bi-lung ventilation in the two groups (P <0.05),and the value of Qs/Qt was significantly lower in the observation group than in the control group for one-lung ventilation (P <0.05).Conclusion The inluence of bronchial occlusive device on respiratory mechanics parameters is smaller than DLT is,which is worthy of widely clin-ical application.%目的：探讨双腔气管导管与支气管封堵器在单肺通气中对老年患者呼吸力学参数的影响。方法选取2013年9月—2015年4月于我院择期行肺叶切除术的老年患者60例作为本次研究的对象并分为 A、B 组，两组分别使用 DLT 和支气管封堵器进行单肺通气，记录并分析两组的呼吸力学参数、肺内分流率。结果单肺通气后，两组的吸气阻力、呼气阻力、气道峰压和吸气平台压均上升明显，肺动态顺应性显著下降（P ＜0.05）；单肺通气时 B 组的吸气阻力、呼气阻力、气道峰压和吸气平台压均较 A 组下降更显著（P ＜0.05或0.01）；麻醉后，两组的 PaO2、PvO2和 Qs／Qt 较麻醉前均显著上升（P ＜0.05）；双肺和单肺通气时相比，两组的 PaO2和 Qs／Qt 变化显著（P ＜0.05）；在单肺通气时 B 组的 Qs／Qt 显著低于 A 组（P ＜0.05）。结论支气管封堵器的使用对老年患者呼吸力学参数的影响较 DLT 更小，值得在临床上推广使用。