單肺通氣中低氧血癥的防治策略_《中國呼吸與危重監護雜志》

作者：

蔡英蔚 , 蔡鐵良 , 沈七襄

解放軍第174醫院麻醉科（福建廈門 361003）;

關鍵詞：

低氧血癥單肺通氣

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單肺通氣技術( OLV) 廣泛應用于開胸手術, 該技術使手術側肺萎陷, 非手術側單肺通氣, 目的是防止手術側肺分泌物或血液流入健側肺, 確保氣道通暢, 防止交叉感染, 避免手術側肺膨脹, 使肺保持安靜以利于手術操作, 減輕對肺實質的損傷。隨著手術日益走向微創時代, 對該技術的需求大量增加。

引用本文： 蔡英蔚,蔡鐵良,沈七襄. 單肺通氣中低氧血癥的防治策略. 中國呼吸與危重監護雜志, 2009, 09(3): 312-314. doi: 復制

1.	Ost D, Corbridge T. Independent lung ventilation. Clin Chest Med, 1996, 17: 591-601.
2.	劉仁玉, 杭燕南. 單肺通氣方法和低氧血癥防治. 臨床麻醉雜志, 1998, 14: 293-294.
3.	Klein U, Karzai W, Bloos F, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology, 1998, 88 : 346 -350.
4.	Watanabe S, Noguchi E, Yamada S, et al. Sequential changes of arterial oxygen tension in the supine position during one-lung ventilation. Anesth Analg, 2000, 90: 28-34.
5.	孫穎, 馮藝, 楊拔賢. 不同麻醉長時間單肺通氣對肺內分流和氧合的影響. 中華麻醉學雜志, 2004, 24: 339-344.
6.	Frerichs I, Dudykevych T, Hinz J, et al. Gravity effects on regional lung ventilation determined by functional EIT during parabolic flights. J Appl Physiol, 2001, 91: 39-50.
7.	陳士壽, 陳燃, 曾一平, 等. 單肺通氣期間體位對血液氧合的影響. 臨床麻醉學雜志, 2006, 22: 193-195.
8.	Beck DH, Doepfmer UR, Sinemus C, et al. Effects of sevoflurane and propofol on pulmonary shunt fraction during one-lung ventilation for thoracic surgery. Br J Anaesth, 2001, 86: 38-43.
9.	Ishikawa S, Nakazawa K, Makita K. Progressive changes in arterial oxygenation during one-lung anaesthesia are related to the response to compression of the non-dependent lung. Br J Anaesth, 2003, 90 :21-26.
10.	Slinger P, Scott WA. Arterial oxygenation during one-lung ventilation. Anesthesiology, 1995, 82: 940-946.
11.	Wang JY, Russell GN, Page RD, et al. A comparison of the effects of desflurane and isoflurane on arterial oxygenation during one-lung ventilation. Anaesthesia, 2000, 55: 167-173.
12.	Pruszkowski O, Dalibon N, Moutafis M, et al. Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth, 2007, 98: 539-544.
13.	Cohen E. Methods of lung separation. Curr Opin Anaesthesiol,2002, 15: 69-78.
14.	Cohen E. Anesthetic management of one-lung ventilation. In:Cohen E, 1 sted. The practice of thoracic anesthesia. Philadelphia:Lippincott, 1995, 308-340.
15.	Slinger P. Choosing the appropriate double-lumen tube: a glimmer of science comes to a dark art. JCardiothorac Vasc Anesth, 1995, 9 :117-118.
16.	Ovassapian A, Randel GI. The role of fiberscope in the critically ill patient. Crit Care Clin, 1995, 11 : 29 -51.
17.	Szegedi LL, Bardoczky GI, Engelman EE, et al. Airway pressure changes during one-lung ventilation. Anesth Analg, 1997, 84: 1034-1037.
18.	Seymour AH, Prasad B, McKenzie RJ. Audit of double-lumen endobronchial intubation. Br J Anaesth, 2004, 93: 525-527.
19.	Rothen HU, Sporre B, Engberg G, et al. Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia. Anesthesiology, 1995 , 82 : 832 -842.
20.	Bernard GR. Acute respiratory distress syndrome: a historical perspective. Am J Respir Crit Care Med, 2005, 172: 798-806.
21.	Fujiwara M, Abe K, Mashimo T. The effect of positive endexpiratory pressure and continous positive airway pressure on the oxygenation and shunt fraction during one-lung ventilation with propofol anesthesia. J Clin Anesth, 2001, 13 : 473-477 .
22.	Valenza F, Ronzoni G, Perrone L, et al. Positive end-expiratory pressure applied to the dependent lung during one lung ventilation improves oxygenation and respiratory mechanics in patients with high FEV1 . Eur J Anaesthesiol, 2004, 21: 938-943.
23.	Inomata S, Nishikawa T, Saito S, et al. Best PEEP during onelung ventilation. Br J Anaesth, 1997, 78: 754-756.
24.	Pavlik M, Ctvrteckova D, Zvonicek V, et al. The improvement of arterial oxygenation during one-lung ventilation effect of different CPAP levels. Acta Chir Hung, 1999, 38: 103-105.
25.	Dalibon N, Moutafis M, Liu N, et al. Treatment of hypoxemia during one-lung ventilation using intravenous almitrine. Anesth Analg, 2004, 98: 590-594.
26.	Moutafis M, Dalibon N, Liu N, et al. The effects of intravenous almitrine on oxygenation and hemodynamics during one-lung ventilation. Anesth Analg, 2002, 94: 830-834.
27.	SticherJ, Scholz S, B　ning O, et al. Small-dose nitric oxide improves oxygenation during one lung ventilation: an experimental study. Anesth Analg , 2002 , 95 : 1557-1562.
28.	Moutafis M, Dalibon N, Colchen A, et al. Improving oxygenation during bronchopulmonary lavage using nitric oxide inhalation and almitrine infusion. Anesth Analg, 1999, 89: 302-304.
29.	Cohen E. Update on thoracic anesthesia. Revista Mexicana de Anesthesiologia, 2006, 29: S58-S61.

1. Ost D, Corbridge T. Independent lung ventilation. Clin Chest Med, 1996, 17: 591-601.
2. 劉仁玉, 杭燕南. 單肺通氣方法和低氧血癥防治. 臨床麻醉雜志, 1998, 14: 293-294.
3. Klein U, Karzai W, Bloos F, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology, 1998, 88 : 346 -350.
4. Watanabe S, Noguchi E, Yamada S, et al. Sequential changes of arterial oxygen tension in the supine position during one-lung ventilation. Anesth Analg, 2000, 90: 28-34.
5. 孫穎, 馮藝, 楊拔賢. 不同麻醉長時間單肺通氣對肺內分流和氧合的影響. 中華麻醉學雜志, 2004, 24: 339-344.
6. Frerichs I, Dudykevych T, Hinz J, et al. Gravity effects on regional lung ventilation determined by functional EIT during parabolic flights. J Appl Physiol, 2001, 91: 39-50.
7. 陳士壽, 陳燃, 曾一平, 等. 單肺通氣期間體位對血液氧合的影響. 臨床麻醉學雜志, 2006, 22: 193-195.
8. Beck DH, Doepfmer UR, Sinemus C, et al. Effects of sevoflurane and propofol on pulmonary shunt fraction during one-lung ventilation for thoracic surgery. Br J Anaesth, 2001, 86: 38-43.
9. Ishikawa S, Nakazawa K, Makita K. Progressive changes in arterial oxygenation during one-lung anaesthesia are related to the response to compression of the non-dependent lung. Br J Anaesth, 2003, 90 :21-26.
10. Slinger P, Scott WA. Arterial oxygenation during one-lung ventilation. Anesthesiology, 1995, 82: 940-946.
11. Wang JY, Russell GN, Page RD, et al. A comparison of the effects of desflurane and isoflurane on arterial oxygenation during one-lung ventilation. Anaesthesia, 2000, 55: 167-173.
12. Pruszkowski O, Dalibon N, Moutafis M, et al. Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth, 2007, 98: 539-544.
13. Cohen E. Methods of lung separation. Curr Opin Anaesthesiol,2002, 15: 69-78.
14. Cohen E. Anesthetic management of one-lung ventilation. In:Cohen E, 1 sted. The practice of thoracic anesthesia. Philadelphia:Lippincott, 1995, 308-340.
15. Slinger P. Choosing the appropriate double-lumen tube: a glimmer of science comes to a dark art. JCardiothorac Vasc Anesth, 1995, 9 :117-118.
16. Ovassapian A, Randel GI. The role of fiberscope in the critically ill patient. Crit Care Clin, 1995, 11 : 29 -51.
17. Szegedi LL, Bardoczky GI, Engelman EE, et al. Airway pressure changes during one-lung ventilation. Anesth Analg, 1997, 84: 1034-1037.
18. Seymour AH, Prasad B, McKenzie RJ. Audit of double-lumen endobronchial intubation. Br J Anaesth, 2004, 93: 525-527.
19. Rothen HU, Sporre B, Engberg G, et al. Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia. Anesthesiology, 1995 , 82 : 832 -842.
20. Bernard GR. Acute respiratory distress syndrome: a historical perspective. Am J Respir Crit Care Med, 2005, 172: 798-806.
21. Fujiwara M, Abe K, Mashimo T. The effect of positive endexpiratory pressure and continous positive airway pressure on the oxygenation and shunt fraction during one-lung ventilation with propofol anesthesia. J Clin Anesth, 2001, 13 : 473-477 .
22. Valenza F, Ronzoni G, Perrone L, et al. Positive end-expiratory pressure applied to the dependent lung during one lung ventilation improves oxygenation and respiratory mechanics in patients with high FEV1 . Eur J Anaesthesiol, 2004, 21: 938-943.
23. Inomata S, Nishikawa T, Saito S, et al. Best PEEP during onelung ventilation. Br J Anaesth, 1997, 78: 754-756.
24. Pavlik M, Ctvrteckova D, Zvonicek V, et al. The improvement of arterial oxygenation during one-lung ventilation effect of different CPAP levels. Acta Chir Hung, 1999, 38: 103-105.
25. Dalibon N, Moutafis M, Liu N, et al. Treatment of hypoxemia during one-lung ventilation using intravenous almitrine. Anesth Analg, 2004, 98: 590-594.
26. Moutafis M, Dalibon N, Liu N, et al. The effects of intravenous almitrine on oxygenation and hemodynamics during one-lung ventilation. Anesth Analg, 2002, 94: 830-834.
27. SticherJ, Scholz S, B　ning O, et al. Small-dose nitric oxide improves oxygenation during one lung ventilation: an experimental study. Anesth Analg , 2002 , 95 : 1557-1562.
28. Moutafis M, Dalibon N, Colchen A, et al. Improving oxygenation during bronchopulmonary lavage using nitric oxide inhalation and almitrine infusion. Anesth Analg, 1999, 89: 302-304.
29. Cohen E. Update on thoracic anesthesia. Revista Mexicana de Anesthesiologia, 2006, 29: S58-S61.

《中國呼吸與危重監護雜志》

單肺通氣中低氧血癥的防治策略

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《中國呼吸與危重監護雜志》

單肺通氣中低氧血癥的防治策略

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