目的 探讨单肺通气利用动态肺顺应性设定呼吸末正压（positive end-expiratory pressure ,PEEP）的优势及可行性。方法 选择预行右侧肺叶切除患者80例，完全随机分为A、B两组，每组40例;A组为实验组，单肺通气实施肺膨胀（sustained inflation，SI）复张后加用20cmH2O的PEEP并递减滴定，随后以得到最大肺顺应性的PEEP值通气，直到恢复双肺通气，B组为对照组，通气PEEP值固定为5cmH2O，其他通气方法同A组。记录患者血气，呼吸等参数。结果 两组设定的PEEP值（A组9.2±1.2 cmH2O，B组5 cmH2O）差异显著（P<0.05）；两组血氧分压（partial pressure of oxygen,PaO2）在单肺通气一小时(T3)、手术结束(T4)时（A组244.1±71.3 mmHg、240±63.2 mmHg，B组212±61.1 mmHg、187.9±79.9 mmHg）差异显著（P<0.05）； B组的PaO2在T3(212±61.1 mmHg）、T4（187.9±49.9 mmHg）逐步降低，差异显著（P<0.05），而A组（244.1±71.3 mmHg、240±63.2 mmHg）则维持较好（P>0.05）；A组的动态肺顺应性在T3（30.8±5.9ml/cmH2O）及T4（30.7±6.4 ml/cmH2O）与B组（26.6±5.5 ml/cmH2O、26.4±5.2 ml/cmH2O）相比差异显著(P<0.05)。结论 胸腔镜肺叶切除术中的单肺通气，利用动态肺顺应性设定的PEEP值通气能够得到更好氧合及呼吸参数，并且维持较好。
Objective the advantage and feasibility of using dynamic compliance identify the positive end-expiratory pressure level in one lung ventilation. Methods 80 patients undergoing video-assisted right pulmonary lobectomy were randomly allocated to group A and group B. group A received an alveolar recruitment(sustained inflation) at the beginning of one-lung ventilation，then ventilated with an individualized PEEP level determined by a PEEP decrement trial which use of dynamic compliance. After the same alveolar recruitment as group A the group B ventilated with 5cmH2O PEEP. Arterial blood gas analysis, lung mechanics were recorded at 5 timepoints throughout the procedure. Results The PEEP values (group A 9.2±1.2 cmH2O,group B 5 cmH2O )was significantly different in two groups（P<0.05), PaO2 at the T3(1 hour after one lung ventilation)、T4 (operation over)timepoints(group A 244.1±71.3 mmHg、240±63.2 mmHg, group B 212±61.1 mmHg、187.9±79.9 mmHg) was significantly different in two groups（P<0.05), During one-lung ventilation, PaO2 at T3(212±61.1 mmHg）、T4（187.9±49.9 mmHg）was decreased in group B(P<0.05),but which was maintained in group A(244.1±71.3 mmHg、240±63.2 mmHg, P>0.05).the dynamic compliance have the same results(group A:T3 30.8±5.9ml/cmH2O,T4 30.7±6.4 ml/cmH2O; group B: T3 26.6±5.5 ml/cmH2O,T426.4±5.2 ml/cmH2O; P<0.05 ). Conclusions The PO2 and lung mechanics were better maintained by using PEEP with decrement trial than 5 cmH2O PEEP during one-lung ventilation that undergoing video-assisted pulmonary lobectomy.
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