【摘要】 目的 通過觀察單肺通氣患者術中氧合指數（oxygenation index，OI）、呼吸指數（respiratory index，RI）及動態肺順應性（dynamic lung compliance，Cdyn）的變化，探討高滲氯化鈉溶液對術中單肺通氣患者的肺保護作用。 方法 選擇2009年12月-2011年2月完成的美國麻醉師協會分級為Ⅰ~Ⅲ級，心肺功能篩查、血常規、肝腎功能及凝血功能無明顯異常，擬在全麻雙腔氣管插管下行開胸手術，術中需行單肺通氣患者60例，隨機分為高滲氯化鈉組（A組）和對照組（B組），每組30例。A組在開始單肺通氣后30 min快速輸注7.5%高滲氯化鈉溶液2 mL/kg，15 min內輸注完畢，B組輸注等量生理鹽水，分別記錄輸注前（T1）、輸注完畢時（T2）、輸注后30 min（T3）、輸注后1 h（T4）的OI、RI及Cdyn變化，并比較兩組各時間點生命體征變化。 結果 兩組患者OI、RI及Cdyn在T1、T2時差異無統計學意義（Pgt;0.05）；兩組患者不同時間點平均動脈壓、心率、脈搏血氧飽和度、中心靜脈壓、呼氣末CO2分壓比較差異無統計學意義（Pgt;0.05）；A組患者在T3、T4時的OI和Cdyn較B組明顯升高，RI明顯降低（Plt;0.05）；且A組患者在T3、T4時的OI和Cdyn較T1時明顯增高，RI明顯降低（Plt;0.05）。 結論 高滲氯化鈉溶液能改善術中單肺通氣患者的OI、RI及Cdyn，對肺功能有一定的保護作用。【Abstract】 Objective To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects. Methods Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared. Results OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (Pgt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (Pgt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (Plt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (Plt;0.05). Conclusion Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.
為了探討高原肺水腫（HAPE）與新型冠狀病毒肺炎（COVID-19）的計算機斷層掃描（CT）特征以及影像鑒別，本研究回顧分析了 2020 年 5 月 1 日至 5 月 30 日解放軍 950 醫院三十里營房醫療站 52 例診斷為 HAPE 患者的胸部 CT 影像資料。分析不同病情階段肺內感染病灶的數量、位置、分布、密度及形態后，與《新型冠狀病毒肺炎的放射學診斷：中華醫學會放射學分會專家推薦意見（第一版）》和《新型冠狀病毒（2019-nCoV）感染的肺炎診療快速建議指南（標準版）》中 COVID-19 CT 相關影像特征比較，找到兩者 CT 影像鑒別方法。研究發現早期 HAPE 與 COVID-19 胸部 CT 均表現為斑片狀磨玻璃影，但后者有特征性“鋪路石”（網格狀小葉內間隔增厚）征象。進展期 HAPE CT 多表現為云絮狀密度增高影，而 COVID-19 病灶多見平行于胸膜方向發展，部分病灶可見支氣管充氣征。重癥爆發期兩者 CT 影像均可見“白肺”表現，但 HAPE 右肺多重于左肺。因此在 HAPE 與 COVID-19 CT 的鑒別診斷中，前者病灶云絮狀密度增高影可作為特征影像征象，而“鋪路石征”和“胸膜平行征”可作為后者的特征 CT 表現。