乐新会 赵栋 黄晓霞

[摘要] 目的 研究選择性单肺叶隔离通气与单肺通气对每搏量变异度的影响。 方法 选择我院2016年5月～2017年5月收治的50例行支气管封堵管通气治疗的患者作为研究对象，将其随机分成对照组和研究组，每组25例，对照组行单肺通气治疗，研究组行选择性单肺叶隔离通气治疗，比较两组患者的手术时间、机械通气时间、住院天数以及患者治疗前后的肺内分流率（Qs/Qt）、每搏量变异度（SVV）、心输出量（CO）、每搏输出量（SV）、中心静脉压（CVP）以及平均动脉压（MAP）等。 结果 两组患者的手术时间、机械通气时间、住院天数比较均无显著差异（P>0.05）；通气治疗前，两组患者的Qs/Qt、SVV、CO、SV、CVP及MAP等比较均无显著差异（P>0.05），治疗后，两组患者的CO、SV、CVP及MAP比较仍无显著差异（P>0.05），但研究组患者的Qs/Qt明显低于对照组，研究组患者的SVV明显高于对照组，差异有统计学意义（P<0.05）。 结论 对行支气管封堵管通气治疗的患者采用选择性单肺叶隔离通气与单肺通气均有一定的功效，但选择性单肺叶隔离通气的肺内分流量更低，且SVV值越高，代表患者体内循环越稳定，因此其可作为患者机体内液体反应能力的重要指标。

[关键词] 选择性单肺叶隔离通气；单肺通气；支气管封堵管；每搏量变异度

[中图分类号] R614；R735 [文献标识码] A [文章编号] 1673-9701（2018）25-0001-04

[Abstract] Objective To study and compare the effects of selective single lobe isolation ventilation and one-lung ventilation on stroke volume variation. Methods 50 patients undergoing bronchial closure tube ventilation who were admitted to our hospital from May 2016 to May 2017 were selected as the research subjects. They were randomly divided into the control group and the study group， with 25 patients in each group. The control group was given one-lung ventilation，and the study group was given selective single lobe isolation ventilation. The surgery time，mechanical ventilation time， length of stay， and intrapulmonary shunt rate （Qs/Qt）， stroke volume variation （SVV）， cardiac output （CO）， and stroke volume（SV）， central venous pressure（CVP），and mean arterial pressure （MAP） before and after the treatment were compared between the two groups of patients. Results There was no significant difference in the surgery time， mechanical ventilation time and length of stay between the two groups（P>0.05）； before ventilation therapy， there was no significant difference in Qs/Qt， SVV， CO， SV，CVP and MAP between the two groups（P>0.05）. After treatment，there was still no significant difference in CO，SV，CVP and MAP between the two groups（P>0.05）. However， Qs/Qt in the study group was significantly lower than that in the control group， and SVV was significantly higher in the study group than in the control group， with significant differences between the two groups（P<0.05）. Conclusion The application of selective single lobe isolation ventilation and one-lung ventilation has a certain efficacy in the patients undergoing bronchial closure tube ventilation. However， the selective single lung isolation ventilation has lower intrapulmonary shunt， and the higher the SVV value，the more stable the circulation in the patient's body. Therefore，it can be used as an important indicator of the fluid response in patients' body.

[Key words] Selective single lobe isolation ventilation； One-lung ventilation； Bronchial closure tube； Stroke volume variation （SVV）

肺叶切除术是治疗肺部肿瘤疾病最有效的方式之一，但是受手术操作和体位的影响，也易增加患者健侧肺气道压力、引发患者发生肺萎缩和顺应性下降等现象，为此，在手术治疗过程中，还需配合支气管封堵管通气方式对患者进行治疗，临床常用的通气方式有选择性单肺叶隔离通气、单肺通气等[1]。不少研究证实，患者行单肺通气时，易发生肺内分流，而行选择性单肺叶隔离通气则能有效降低肺内分流，从而能够提高其机体的每搏量变异度[2-5]。本文主……