单肺通气前低氧预处理对肺叶切除术患者氧合的影响.

To investigate the effect of hypoxic preconditioning (HPC) before single-lung ventilation on oxygenation in patients with pulmonary lobectomy. Methods Fifty-eight patients who underwent elective lobectomy in our hospital were selected in this study. Patients were divided into treatment group (group P) and control group (group N) according to the random number table, with 29 cases in each group. After anesthesia-induced intubation and before onelung ventilation (OLV), hypoxia was used to reduce SpO2 to 0.90 in group P, and then reoxygenation was used to increase SpO2 to 1.00. The ventilation was continued for 3 minutes, and repeated twice. The arterial blood, gas was measured at the end of each treatment, and the hypoxia tolerance time of SpO2 from 1.00 to 0.90 was recorded. Group N was subjected to routine ventilation. Radial arterial and internal jugular vein blood were taken for blood, gas and intrapulmonary shunt rate (Qs/Qt) was measured before and after OLV (T0), OLV 30 min (T1), OLV 60 min (T2) and OLV 90 min (T3). Platelet (PLT) and mean platelet volume (MPV) were measured at T0, T1, T2 and T3. The OLV time, vital signs at each time point during the operation and peak airway pressure (Peak) were also recorded. Results There were no significant differences in OLV time, the average arterial pressure (MAP), SpO2, heart rate (HR), Peak, p(CO2), pH, hemoglobin (Hb) and arterial blood oxygen saturation (SaO2) during operation between the two groups (P＞0.05). During the two HPC sessions, the hypoxia tolerance time was extended from (6.9±1.3) min to (7.9±1.1) min (P＜0.05), and no serious adverse reactions were observed. After OLV, the levels of p(O2) were significantly lower in the two groups than before OLV, but the levels of p(O2) were significantly lower at each time point in the group N than that in the group P(P＜0.05). After OLV, the Qs/Qt values were significantly higher than those before OLV in the two groups, and the Qs/Qt of each time point was higher in the group N than that of the group P (P＜0.05). There were no significant differences in PLT and MPV between the two groups (P＞0.05). Conclusion Hypoxic pretreatment before one-lung ventilation is safe for patients. It can reduce Qs/Qt in patients during OLV, increase p(O2) and improve the oxygenation of patients undergoing lobectomy. The relationship between its effect and platelet count and function is not clear. [ABSTRACT FROM AUTHOR]