Saito S, Okubo N, Inomata S, Dohi S, Naito H
Department of Anesthesiology, University of Tsukuba, Ibaraki.
Masui. 1991 Jan;40(1):2-10.
Hemodynamic changes during positive airway pressure ventilation is well known. To compare changes of hemodynamic variables during one-lung inflation with those during two-lung inflation, we studied the effects of lung inflation on hemodynamic changes in 15 anesthetized patients who were intubated endobronchially. When the airway pressure was increased from 0 cmH2O to 10, 20, 30 cmH2O, systolic pressure decreased gradually and central venous pressure increased during both two-lung and one-lung inflations (P less than 0.05). During one-lung inflation, the decrease in arterial pressure relative to apneic arterial pressure was significantly less than those during two-lung inflation at each level of airway pressure (P less than 0.05). During one-lung inflation, central venous pressure which was higher relative to apneic central venous pressure, and was less than that during two-lung inflation at 30 cmH2O (P less than 0.05). Heart rate was unchanged during both two and one-lung inflations compared with apneic heart rate. We conclude that during one-lung inflation, systolic pressure and central venous pressure are influenced less by the increased airway pressure than during two-lung inflation. The results indicate that during one lung ventilation, lungs inflated with clinically accepted levels of airway pressure do not depress the systemic circulation, but when the airway pressure during one-lung inflation (like a leak test) exceeded over 30 cmH2O, a significant depression of the systemic circulation occurs.
气道正压通气期间的血流动力学变化是众所周知的。为了比较单肺通气和双肺通气期间血流动力学变量的变化，我们研究了肺膨胀对15例经支气管内插管的麻醉患者血流动力学变化的影响。当气道压力从0 cmH₂O增加到10、20、30 cmH₂O时，双肺通气和单肺通气期间收缩压均逐渐降低，中心静脉压升高（P<0.05）。在单肺通气期间，在每个气道压力水平下，相对于呼吸暂停时动脉压的动脉压降低显著小于双肺通气期间（P<0.05）。在单肺通气期间，相对于呼吸暂停时中心静脉压较高的中心静脉压，在30 cmH₂O时低于双肺通气期间（P<0.05）。与呼吸暂停时心率相比，双肺通气和单肺通气期间心率均无变化。我们得出结论，在单肺通气期间，收缩压和中心静脉压受气道压力增加的影响小于双肺通气期间。结果表明，在单肺通气期间，用临床可接受的气道压力水平充气的肺不会抑制体循环，但当单肺通气期间的气道压力（如漏气试验）超过30 cmH₂O时，会出现明显的体循环抑制。
