Lee Su Hyun, Kim Namo, Kim Hyun Il, Oh Young Jun
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine Seoul, Republic of Korea.
Int J Clin Exp Med. 2015 Aug 15;8(8):13099-108. eCollection 2015.
The intra-pulmonary shunt induced by one-lung ventilation (OLV), is alleviated by increased pulmonary blood flow by gravitational redistribution and hypoxic pulmonary vasoconstriction. We investigated the changes of pulmonary venous blood flow (PVBF) and biventricular function during OLV with echocardiography. And the correlation between PVBF and intra-pulmonary shunt fraction (Qs/Qt) was evaluated.
PVBF of the left upper pulmonary vein and cardiac function were measured with echocardiography in twenty-five patients who underwent elective thoracic surgery in left lateral decubitus. Qs/Qt and PaO2 were measured with blood gas analysis. Data was obtained at 10 min after two-lung ventilation in supine (TLV-S) and lateral decubitus position (TLV-L), and at 10, 20 and 30 min after OLV in lateral decubitus position (OLV-10, -20 and -30).
There were significant changes in PVBF among TLV-S, TLV-L and OLV-10 (959.5±280.8, 1416.9±489.7 and 1999.9±670.5 ml/min; P<0.05, respectively). There were not differences in PVBF, Qs/Qt and PaO2 among OLV-10, -20 and -30. There were an inverse correlation between percent change of PVBF and change of Qs/Qt (r(2) = 0.5; P<0.0001) and positive correlations between the percent change of PVBF and change of PaO2 (r(2) = 0.4; P<0.0001) during OLV over TLV-L. No significant changes in biventricular systolic and diastolic function were observed during positional change and OLV.
A remarkable change of PVBF relevant to gravitational distribution and hypoxic pulmonary vasoconstriction was proved by echocardiography. And PVBF changes could represent the changes of Qs/Qt and PaO2 during OLV. However, biventricular function was not impaired during OLV.
单肺通气（OLV）所诱导的肺内分流可通过重力再分布和缺氧性肺血管收缩增加肺血流量来缓解。我们采用超声心动图研究了OLV期间肺静脉血流量（PVBF）和双心室功能的变化。并评估了PVBF与肺内分流分数（Qs/Qt）之间的相关性。
对25例行择期胸外科手术的左侧卧位患者，采用超声心动图测量左上肺静脉的PVBF和心功能。通过血气分析测量Qs/Qt和动脉血氧分压（PaO2）。在仰卧位双肺通气（TLV-S）和侧卧位双肺通气（TLV-L）后10分钟，以及侧卧位OLV后10、20和30分钟（OLV-10、-20和-30）获取数据。
TLV-S、TLV-L和OLV-10之间的PVBF有显著变化（分别为959.5±280.8、1416.9±489.7和1999.9±670.5 ml/分钟；P<0.05）。OLV-10、-20和-30之间的PVBF、Qs/Qt和PaO2没有差异。在OLV相对于TLV-L期间，PVBF的百分比变化与Qs/Qt的变化呈负相关（r² = 0.5；P<0.0001），PVBF的百分比变化与PaO2的变化呈正相关（r² = 0.4；P<0.0001）。在体位改变和OLV期间，未观察到双心室收缩和舒张功能有显著变化。
超声心动图证实了与重力分布和缺氧性肺血管收缩相关的PVBF有显著变化。并且PVBF变化可代表OLV期间Qs/Qt和PaO2的变化。然而，OLV期间双心室功能未受损。
