背景:单肺通气(OLV)在电视胸腔镜手术(VATS)气道管理中经常使用,以塌陷和隔离非依赖性肺(NL)。OLV可由于产生的肺分流而引起低氧血症。我们的研究旨在评估持续气道正压通气(CPAP)联合小潮气量通气对改善动脉氧合和降低肺分流率(QS/QT)的影响,而不影响OLV期间的手术视野暴露。
方法:本研究纳入48例接受定期VATS肺叶切除术的患者,随机分为三组:C组(常规通气,未进行NL通气干预),LP组(NL用较低的CPAP[2cmH2O]和40-60mL潮气量[TV]通气),和HP组(NL用较高的CPAP[5cmH2O]和60-80mLTV通气)。记录血气分析数据并计算以下时间的QS/QT:在OLV开始时(T0),OLV(T1)后30分钟,和OLV后60分钟(T2)。邀请对通气技术视而不见的外科医生评估手术野。
结果:三组的人口统计学数据与手术数据一致。T1时,HP组PaO2明显高于C组(P<0.05),而LP组无显著性差异(P>0.05)。在T1-T2时,LP和HP组PaCO2显著低于C组(P<0.05)。T1时,C组的QS/QT值,LP,HP为29.54±6.89%,22.66±2.08%,和19.64±5.76%,分别,LP和HP组的QS/QT值均明显降低(P<0.01)。3组手术术野评价不显著(P>0.05)。
结论:CPAP联合小潮气量通气可有效改善动脉氧合,降低QS/QT和PaCO2,而不影响OLV期间的手术视野暴露。其中,5cmH2OCPAP+60~80ml电视通气对改善氧合效果较好。
BACKGROUND: One-lung ventilation (OLV) is frequently applied during video-assisted thoracoscopic surgery (VATS) airway management to collapse and isolate the nondependent lung (NL). OLV can give rise to hypoxemia as a result of the pulmonary shunting produced. Our study aimed to assess the influence of continuous positive airway pressure (CPAP) combined with small-tidal-volume ventilation on improving arterial oxygenation and decreasing pulmonary shunt rate (QS/QT) without compromising surgical field exposure during OLV.
METHODS: Forty-eight patients undergoing scheduled VATS lobectomy were enrolled in this research and allocated into three groups at random: C group (conventional ventilation, no NL ventilation intervention was performed), LP group (NL was ventilated with lower CPAP [2 cmH2O] and a 40-60 mL tidal volume [TV]), and HP group (NL was ventilated with higher CPAP [5 cmH2O] and a 60-80 mL TV). Record the blood gas analysis data and calculate the QS/QT at the following time: at the beginning of the OLV (T0), 30 min after OLV (T1), and 60 min after OLV (T2). Surgeons blinded to ventilation techniques were invited to evaluate the surgical fields.
RESULTS: The demography data of the three groups were consistent with the surgical data. At T1, PaO2 in the HP group was substantially higher compared to the C group (P < 0.05), while there was no significant difference in the LP group (P > 0.05). At T1-T2, PaCO2 in the LP and HP groups was significantly less than that in the C group (P < 0.05). At T1, the QS/QT values of groups C, LP, and HP were 29.54 ± 6.89%, 22.66 ± 2.08%, and 19.64 ± 5.76%, respectively, and the QS/QT values in the LP and HP groups markedly reduced (P < 0.01). The surgical field\'s evaluation by the surgeon among the three groups was not notable (P > 0.05).
CONCLUSIONS: CPAP combined with small-tidal-volume ventilation effectively improved arterial oxygenation and reduced QS/QT and PaCO2 without compromising surgical field exposure during OLV. Among them, 5 cmH2O CPAP + 60-80 ml TV ventilation had a better effect on improving oxygenation.