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经食管超声心动图评价左侧卧位小潮气量呼气末正压单肺通气患者血流动力学变化

陈广俊 叶铁虎 黄宇光 罗爱伦 李单青

陈广俊, 叶铁虎, 黄宇光, 罗爱伦, 李单青. 经食管超声心动图评价左侧卧位小潮气量呼气末正压单肺通气患者血流动力学变化[J]. 协和医学杂志, 2011, 2(4): 313-318. doi: 10.3969/j.issn.1674-9081.2011.04.007
引用本文: 陈广俊, 叶铁虎, 黄宇光, 罗爱伦, 李单青. 经食管超声心动图评价左侧卧位小潮气量呼气末正压单肺通气患者血流动力学变化[J]. 协和医学杂志, 2011, 2(4): 313-318. doi: 10.3969/j.issn.1674-9081.2011.04.007
Guang-jun CHEN, Tie-hu YE, Yu-guang HUANG, Ai-lun LUO, Shan-qing LI. Evaluation of Hemodynamic Status by Transesophageal Echo-cardiography during One-lung Ventilation with Low Tidal Volume and Positive End-expiratory Pressure in Left Lateral Position[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(4): 313-318. doi: 10.3969/j.issn.1674-9081.2011.04.007
Citation: Guang-jun CHEN, Tie-hu YE, Yu-guang HUANG, Ai-lun LUO, Shan-qing LI. Evaluation of Hemodynamic Status by Transesophageal Echo-cardiography during One-lung Ventilation with Low Tidal Volume and Positive End-expiratory Pressure in Left Lateral Position[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(4): 313-318. doi: 10.3969/j.issn.1674-9081.2011.04.007

经食管超声心动图评价左侧卧位小潮气量呼气末正压单肺通气患者血流动力学变化

doi: 10.3969/j.issn.1674-9081.2011.04.007
详细信息
    通讯作者:

    陈广俊 电话:010-65295621, E-mail:charlesgjchen31@yahoo.com.cn

  • 中图分类号: R614.2;R332

Evaluation of Hemodynamic Status by Transesophageal Echo-cardiography during One-lung Ventilation with Low Tidal Volume and Positive End-expiratory Pressure in Left Lateral Position

More Information
  • 摘要:   目的  应用经食管超声心动图(transesophageal echocardiography, TEE)评价左侧卧位开胸手术患者采用小潮气量呼气末正压(positive end-expiratory pressure, PEEP)单肺通气时的血流动力学变化。  方法  选择本院美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级Ⅰ-Ⅱ级择期行左侧卧位开胸肺叶切除手术患者10例。在全麻诱导后采用小潮气量呼气末正压通气, 潮气量4~6 ml/kg, PEEP 4~6 cm H2O, 呼吸频率12~16次/min。维持呼气末二氧化碳(end-tidal carbon dioxide, EtCO2)35~40 mm Hg, SpO2 > 96%, 并持续至研究观察结束。全麻诱导后30 min(约中心静脉穿刺后15 min)时测量患者平卧位双肺通气时的心率(heart rate, HR)、血压(blood pressure, BP)、中心静脉压(central venous pressure, CVP), 同时应用TEE经胃左心室中段短轴测量左室射血分数(left ventricular ejection fraction, EF)、每搏量(stroke volume, SV)、心输出量(cardiac output, CO)、心脏指数(cardiac index, CI)、每搏指数(stroke index, SI)、左室收缩末期容积(left ventricular end-systolic volume, LVESV)、左室舒张末期容积(left ventricular end-diastolic volume, LVEDV)、左室内径缩短分数(left ventricular dimension fractional shortening, LVDFS)和体循环阻力(systemic vascular resistance, SVR)。平卧位测试完毕后将患者移至左侧卧位, 胸腔打开前单肺通气, 于胸腔打开后约15 min同样测定上述参数, 数据测量结束后撤出食管探头, 结束实验。  结果  在小潮气量PEEP通气模式下, 左侧卧位单肺通气时的SV和SI较平卧位双肺通气时显著增高, 分别为(69.23±20.01)ml vs.(56.97±22.02)ml和(40.67±8.35)ml/m2 vs.(32.45±8.79)ml/m2(P < 0.05), 但HR、SBP、DBP和CVP两种体位比较差异无统计学意义; 且LVEF、CO、CI、LVESV、LVEDV、LVDFS和SVR比较差异也无统计学意义。  结论  在小潮气量呼气末正压通气模式下, 与平卧位双肺通气比较, 左侧卧位单肺通气不影响患者的心功能和血流动力学。
  • 表  1  两种体位下患者呼吸参数比较(n = 10,x±s)

    体位 VT (ml) RR (次/min) PEEP (cm H2 O) 气道峰压(cm H2 O) EtCO2 (mm Hg) SpO2
    平卧位 412. 00 ± 55. 78 14. 44 ± 1. 24 5. 67 ± 0. 50 16. 00 ± 2. 70 35. 33 ± 2. 60 99. 22 ± 0. 44
    左侧卧位 404. 44 ± 60. 88 14. 22 ± 1. 10 5. 67 ± 0. 50 26. 33 ± 2. 50* 36. 89 ± 1. 54 98. 22 ± 0. 97*
    VT:潮气量; RR:呼吸频率; PEEP:呼气末正压; EtCO2呼气末二氧化碳: SpO2 :血氧饱和度; 与平卧位比较,* P<0. 05
    下载: 导出CSV

    表  2  两种体位下患者血流动力学参数比较(n = 10,x±s)

    体位 HR (次/min) SBP (mm Hg) DBP (mm Hg) CVP (mm Hg) EF (%) SV (ml) CO (ml /min) CI [ml / (min·m2)] SI (ml /m2) LVESV (ml) LVEDV (ml) LVDFS (%) SVR [dyn / (s·cm5)]
    平卧位 79. 33 ± 2. 50 119. 44 ± 6. 44 78. 11 ± 8. 39 6. 56 ± 2. 35 64. 11 ± 15. 45 56. 97 ± 22. 02 4. 52 ± 1. 77 2. 57 ± 0. 71 32. 45 ± 8. 79 34. 30 ± 21. 50 90. 82 ± 34. 63 39. 03 ± 10. 93 1685. 88 ± 558. 10
    左侧卧位 78. 33 ± 3. 61 121. 33 ± 6. 14 76. 56 ± 8. 86 7. 44 ± 2. 96 66. 11 ± 10. 81 69. 23 ± 20. 01* 5. 30 ± 1. 74 3. 06 ± 0. 86 40. 67 ± 8. 35* 36. 94 ± 15. 57 106. 2 ± 28. 01 42. 78 ± 17. 73 1420. 30 ± 575. 24
    HR:心率; SBP:收缩压; DBP:舒张压; CVP:中心静脉压; EF:左室射血分数; SV:每搏量; CO:心输出量; CI:心脏指数; SI:每搏指数; LVESV:左室收缩末期容积; LVEDV:左室舒张末期容积; LVDFS:左室内径缩短分数; SVR:体循环阻力; 与平卧位比较,* P<0. 05
    下载: 导出CSV
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  • 收稿日期:  2011-08-08
  • 刊出日期:  2011-10-30

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