驱动压指导通气策略对婴儿胸腔镜手术 单肺通气时脑部氧合的影响.

Objective To investigate the effect of driving pressure (DP) guided ventilation strategy on regional cerebral oxygen saturation (SrcO2) in infants with one lung ventilation (OLV) during thoracoscopic surgery. Methods Sixty infants undergoing elective thoracoscopic surgery were randomly divided into control group (group C, n = 30)and driving pressure group (group DP, n = 30). Near infrared spectroscopy was used to monitor SrcO2 during OLV. Cerebral oxygen desaturation (COD)was defined as SrcO2 decreased by more than 20% from baseline. The incidence of hypotension, time of ventilation rescue, the incidence of COD and its duration during OLV were recorded. MAP, HR, SrcO2, PEEP, airway peak pressure (Ppeak), static lung compliance (Cs) were recorded before (T1), 30 min after (T2) and 60 min after (T3)artificial pneumothorax, and results of arterial blood gas analysis on T1 and were T2 compared. Results There were no significant differences in the SrcO2 baseline, the mean SrcO2 during OLV, the incidence of hypotension and the incidence of COD between the two groups (P > 0.05). Times of ventilation rescue and COD duration in DP group were lower than those in C group (P < 0.05). There were no significant differences in MAP, HR, SrcO2, Ppeak, Cs, PaO2 and OI between the two groups at T1 (P > 0.05). Compared with T1, Ppeak increased and SrcO2 and Cs decreased in both groups at T2 and T3 (P < 0.05). Compared with group C, group DP had higher PaO2 and OI at T2, lower Ppeak and higher PEEP and Cs at T2 and T3 (P < 0.05). Conclusion DP guided ventilation strategy improved lung compliance, increased oxygen saturation and shortened the exposure of COD in infants during OLV. [ABSTRACT FROM AUTHOR]