呼气末正压对压力控制单肺通气期间通气和氧合参数的影响。

Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation.

作者信息

Sentürk N Mert, Dilek Ahmet, Camci Emre, Sentürk Evren, Orhan Mukadder, Tuğrul Mehmet, Pembeci Kamil

机构信息

Department of Anaesthesiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

出版信息

J Cardiothorac Vasc Anesth. 2005 Feb;19(1):71-5. doi: 10.1053/j.jvca.2004.11.013.

OBJECTIVES

The purpose of this study was to investigate the effects of PEEP on oxygenation and airway pressures during PCV-OLV.

DESIGN

Randomized, crossover, clinical study.

SETTING

University hospital.

PARTICIPANTS

Twenty-five patients undergoing thoracotomy.

INTERVENTIONS

During the first 5 minutes of OLV, all patients were ventilated with VCV (PEEP: 0) (VCV-ZEEP). Afterward, ventilation was changed to PCV with PEEP: 0 (PCV-ZEEP) or PEEP: 4 cmH2O (PCV-PEEP) for 20 minutes. In the following 20 minutes, PCV-PEEP and PCV-ZEEP were applied in reverse sequence.

MEASUREMENTS AND MAIN RESULTS

At the end of VCV-ZEEP airway pressures (peak airway pressure, plateau airway pressure, mean airway pressure, and pause airway pressure) were recorded. At the end of PCV-PEEP and PCV-ZEEP airway pressures, PaO2 and Qs/Qt were recorded. Ppeak and Pplat were significantly lower with PCV-PEEP compared with VCV-ZEEP (eg, Ppeak: 33.4+/-4.2, 28.3+/-4.1, and 28.9+/-3.7 cmH2O in VCV-ZEEP, PCV-ZEEP, and PCV-PEEP, respectively; p<0.05 for PCV-ZEEP v VCV-ZEEP and PCV-PEEP v VCV-ZEEP). PCV-PEEP was associated with an increased PaO2 (230.3+/-69.8 v 189.0+/-54.8 mmHg, p<0.05) and decreased Qs/Qt (33.4%+/-7.3% v 38.4%+/-5.7%, p<0.05) compared with PCV-ZEEP (mean+/-SD). Eighty-eight percent of the patients have benefited from PEEP.

CONCLUSION

During OLV, PCV with a low level of PEEP leads to improved oxygenation with lower airway pressures.

目的

本研究旨在探讨在压力控制通气-单肺通气（PCV-OLV）期间呼气末正压（PEEP）对氧合及气道压力的影响。

设计

随机、交叉、临床研究。

地点

大学医院。

参与者

25例行开胸手术的患者。

干预措施

在单肺通气的前5分钟，所有患者接受容量控制通气（PEEP：0）（VCV-ZEEP）。之后，通气模式改为PEEP为0（PCV-ZEEP）或PEEP为4 cmH₂O（PCV-PEEP）的压力控制通气，持续20分钟。在接下来的20分钟内，PCV-PEEP和PCV-ZEEP以相反顺序应用。

测量指标及主要结果

在VCV-ZEEP结束时记录气道压力（气道峰压、平台压、平均气道压和呼气末气道压）。在PCV-PEEP和PCV-ZEEP结束时记录气道压力、动脉血氧分压（PaO₂）和分流率（Qs/Qt）。与VCV-ZEEP相比，PCV-PEEP时的气道峰压（Ppeak）和平台压（Pplat）显著降低（例如，VCV-ZEEP、PCV-ZEEP和PCV-PEEP时的Ppeak分别为33.4±4.2、28.3±4.1和28.9±3.7 cmH₂O；PCV-ZEEP与VCV-ZEEP相比以及PCV-PEEP与VCV-ZEEP相比，p<0.05）。与PCV-ZEEP相比（均值±标准差），PCV-PEEP可使PaO₂升高（230.3±69.8对189.0±54.8 mmHg，p<0.05），Qs/Qt降低（33.4%±7.3%对38.4%±5.7%，p<0.05）。88%的患者从PEEP中获益。

结论

在单肺通气期间，低水平PEEP的压力控制通气可改善氧合并降低气道压力。