Effect of different levels of positive pressure during one-lung ventilation on blood gas and hemodynamics in patients with thoracoscopic lung bullae resection surgery / 中国医师进修杂志

ABSTRACT

Objective To investigate the effect of different levels of positive pressure (PEEP) during one-lung ventilation on blood gas and hemodynamics in patients with thoracoscopic lung bullae resection surgery.Methods Seventy-eight patients undergoing thoracoscopic lung bullae resection surgery were divided into three groups by random number table method,26 cases in eachgroup Ⅰ was only given one-lung intermittent positive pressure ventilation (IPPV) after two-lung ventilation,group Ⅱ was given one-lung IPPV and PEEP 5 cmH2O (1 cmH2O =0.098 kPa) after two-lung ventilation,group Ⅲ was given one-lung IPPV and PEEP 10 cmH2O after two-lung ventilation.Blood gas and hemodynamics were recorded and compared in the supine position and lateral position two-lung ventilation,one lung ventilation 10 and 30 min among three groups.Results Oxygen saturation was maintained at 0.99-1.00 in three groups.pH value,base excess,arterial carbondioxide partial pressure (PaCO2) and HCO3-at each time point in three groups had no statistical significance (P ＞ 0.05).Arterial oxygen partial pressure (PaO2) in group Ⅱ and group Ⅲ at one-lung ventilation 10,30 min was significantly higher than that in group Ⅰ [(336.2 ± 113.2),(348.5 ± 109.7) mmHg (1 mmHg =0.133 kPa) vs.(285.0 ± 103.5) mmHg,(357.6 ± 104.0),(358.9 ±103.2) mmHg vs.(276.0 ± 107.2) mmHg] (P ＜0.05),but were within the normal range,there was no statistical difference between group Ⅱ and group Ⅲ (p ＞ 0.05).Heart rate,mean arterial pressure,left ventricular ejection time,systemic vascular resistance at each time point in three groups had no statistical significance (P ＞0.05).Stroke volume,cardiac output in group Ⅱ and group Ⅲ at one-lung ventilation 10,30 min were lower than those in supine position and lateral position two-lung ventilation and the same period in group Ⅰ (P ＜ 0.05),but were within the normal range,there were no statistical differences between group Ⅱ and group Ⅲ (p ＞ 0.05).Conclusions Two-lung ventilation after one-lung IPPV and PEEP 5 cmH2O in thoracoscopic lung bullae resection surgery can maintain satisfactory PaO2 and PaCO2,hemodynamic change is not obvious; PEEP 5 cmH2O compares with only IPPV can further improve PaO2,but PEEP 10 cmH20 can't further improve PaO2.