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目的 探讨小儿单肺通气期间采用定容 (VCV)和定压 (PCV)两种不同通气模式对血流动力学、呼吸力学及血气的影响。方法 按美国麻醉协会病人全身情况评估 (ASA)I～II级择期行结扎术的先天性动脉导管未闭 (PDA)病儿 2 0例 ,麻醉诱导后气管插管 ,右侧卧位 ,先行双肺定容通气 (TLV VCV) ,再采用右肺单肺定容通气 (OLV VCV) ,2 5min后改为单肺定压通气 (OLV PCV) ,用旁气流通气监测法 (SSS)监测TLV VCV、OLV VCV、OLV PCV期间的呼吸力学参数 (Ppeak、Pplat、Raw、Cdyn、Mvi、Mve) ,同时经食管超声多普勒 (TED)监护仪连续监测血流动力学参数 (CO、SVR、SV、LVETi、ACC) ,并取动脉血作血气分析 (PaO2 、PaCO2 )。结果 单肺定容通气与双肺定容通气相比 ,Ppeak、Pplat、Raw显著增高 (P <0 0 1) ,Cdyn显著下降 (P <0 0 1) ;CO、SV显著下降 (P <0 0 5 ) ,SVR显著增加 (P <0 0 5 ) ;动脉血PaO2 显著下降 (P <0 0 1)。单肺定压通气与单肺定容通气相比 ,动脉血PaO2 显著上升 (P <0 0 5 )。结论 单肺通气可使气道压力阻力增加 ,肺顺应性下降 ,动脉血氧分压降低 ,外周血管阻力增加 ,心输出量下降 ;小儿单肺通气期间 ,采取定压通气模式 ,有利于改善肺泡氧合 ,预防和减轻单肺通气造成的低氧血症。
Objective To investigate the effects of two different ventilation modes of constant volume (VCV) and constant pressure (PCV) on hemodynamics, respiration mechanics and blood gas during single-lung ventilation in children. Methods Twenty patients with congenital patent ductus arteriosus (PDA) who underwent ASA I-II elective ligation were enrolled in this study. Tracheal intubation, right lateral decubitus, (TLV VCV). Then OLVVVV was used, OLV PCV was changed after 25 minutes, and TLV VCV was monitored by paraventricular flow ventilation (SSS) (Ppeak, Pplat, Raw, Cdyn, Mvi, Mve) during OLV, OLV, and OLV PCV respectively. The hemodynamic parameters (CO, SVR, SV , LVETi, ACC), and arterial blood for blood gas analysis (PaO2, PaCO2). Results Compared with fixed volume ventilation in both lungs, Ppeak, Pplat and Raw significantly increased (P <0.01), Cdyn decreased significantly (P <0.01), and CO and SV decreased significantly 0 5), SVR increased significantly (P <0 05); arterial blood PaO2 decreased significantly (P 0 01). Compared with single lung volume ventilation, pulmonary arterial blood PaO2 increased significantly (P <0.05). Conclusions Single lung ventilation can increase airway pressure resistance, decrease pulmonary compliance, decrease arterial oxygen tension, increase peripheral vascular resistance, and decrease cardiac output. During the one-lung ventilation in children, constant pressure ventilation mode is helpful to improve pulmonary alveolus Oxygenation, prevention and reduction of hypoxemia caused by one lung ventilation.