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利用自制的气道正压装置 ,对单肺通气下开胸病人的无通气肺施加持续气道正压 ,观察无通气肺接受不同水平的持续气道正压时对动脉氧合的影响。方法 19例需在单肺通气下开胸手术的病人 (ASA :1～ 2级 ) ,随机分成 2组 ,组Ⅰ (n =10 ) :对无通气肺施加 0 2 94kPa (3cmH2 O)的气道持续正压 (CPAP - 3) ;组Ⅱ (n =9) :对无通气肺施加 0 490kPa (5cmH2 O)的气道持续正压 (CPAP - 5 )。于手术前侧卧双肺通气时、单肺通气时、肺血管结扎前的单肺通气加CPAP - 3(组Ⅰ )或单肺通气加CPAP - 5 (组Ⅱ )肺切除后侧卧双肺通气时采血气。结果 与双肺通气相比 ,两组单肺通气时PaO2 明显降低 (组Ⅰ :2 2 93± 9 47kPa ,组Ⅱ :2 0 44± 8 42kPa)。组Ⅰ应用CPAP - 3后PaO2 显著增加 (从单肺通气时的 2 2 93± 9 47kPa增加到36 2 7± 10 13kPa) (P≤ 0 0 5 ) ,组Ⅱ应用CPAP - 5后PaO2 显著增加 (从单肺通气时的 2 0 44± 8 42kPa增加到 5 2 93± 8 5 3kPa)(P≤ 0 0 5 )。而组Ⅰ和组Ⅱ两组间在双肺通气和单肺通气时PaO2 的比较无差异。在组ⅡCPAP - 5时PaO2 (5 2 93± 8 5 3kPa)明显高于组ⅠCPAP - 3时PaO2 (36 2 7± 10 13kPa)。结论 CPAP(0 2 9kPa和 0 490kPa)用于无通气肺可有效改善单肺通气时的动脉?
Using self-made positive airway pressure device, continuous positive airway pressure was applied to non-ventilated lung of patients with thoracotomy under single lung ventilation. The effects of different levels of continuous positive airway pressure on arterial oxygenation were observed in non-ventilated lungs. Methods Nineteen patients (ASA grade 1 ~ 2) undergoing thoracotomy under single lung ventilation were randomly divided into 2 groups (n = 10): 0 2 94 kPa (3 cmH 2 O) gas was applied to non-ventilated lung Continuous CPAP (CPAP - 3); Group Ⅱ (n = 9): Continuous positive airway pressure (CPAP - 5) of 0 490 kPa (5 cm H 2 O) One lung was ventilated with a single lung ventilation before CPAP plus CPAP - 3 (group Ⅰ) or CPAP - 5 (group Ⅱ) with lung ventilation after single lung ventilation. Ventilation when blood gas. Results PaO2 was significantly lower in both groups when compared with those with dual lung ventilation (group I: 2293 ± 9 47 kPa, group II: 2044 ± 8 42 kPa). PaO2 significantly increased (from 2293 ± 477kPa to 3627 ± 1013kPa in one-lung ventilation) (P≤0 05) after treatment with CPAP-3 in group I, PaO2 significantly increased in group II after CPAP-5 (From 2044 ± 8 42 kPa at the time of single lung ventilation to 5293 ± 853 kPa) (P ≦ 0 0 5). However, there was no difference in PaO2 between group I and group II in both lung ventilation and one lung ventilation. PaO2 (5 2 93 ± 8 5 3kPa) was significantly higher in group Ⅱ CPAP - 5 than that in group Ⅰ CPAP - 3 (36 2 7 ± 10 13kPa). Conclusions CPAP (0 2 9kPa and 0 490kPa) for non-ventilated lungs can effectively improve the arterial pressure during single lung ventilation.