• 解放軍第174醫(yī)院麻醉科（福建廈門 361003）;

單肺通氣技術(shù)( OLV) 廣泛應(yīng)用于開胸手術(shù), 該技術(shù)使手術(shù)側(cè)肺萎陷, 非手術(shù)側(cè)單肺通氣, 目的是防止手術(shù)側(cè)肺分泌物或血液流入健側(cè)肺, 確保氣道通暢, 防止交叉感染, 避免手術(shù)側(cè)肺膨脹, 使肺保持安靜以利于手術(shù)操作, 減輕對(duì)肺實(shí)質(zhì)的損傷。隨著手術(shù)日益走向微創(chuàng)時(shí)代, 對(duì)該技術(shù)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(jiān)護(hù)雜志, 2009, 09(3): 312-314. doi: 復(fù)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(shí)間單肺通氣對(duì)肺內(nèi)分流和氧合的影響. 中華麻醉學(xué)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(duì)血液氧合的影響. 臨床麻醉學(xué)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. 1. Ost D, Corbridge T. Independent lung ventilation. Clin Chest Med, 1996, 17: 591-601.
  2. 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. 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. 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. 5. 孫穎, 馮藝, 楊拔賢. 不同麻醉長時(shí)間單肺通氣對(duì)肺內(nèi)分流和氧合的影響. 中華麻醉學(xué)雜志, 2004, 24: 339-344.
  6. 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. 7. 陳士壽, 陳燃, 曾一平, 等. 單肺通氣期間體位對(duì)血液氧合的影響. 臨床麻醉學(xué)雜志, 2006, 22: 193-195.
  8. 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. 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. 10. Slinger P, Scott WA. Arterial oxygenation during one-lung ventilation. Anesthesiology, 1995, 82: 940-946.
  11. 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. 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. 13. Cohen E. Methods of lung separation. Curr Opin Anaesthesiol,2002, 15: 69-78.
  14. 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. 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. 16. Ovassapian A, Randel GI. The role of fiberscope in the critically ill patient. Crit Care Clin, 1995, 11 : 29 -51.
  17. 17. Szegedi LL, Bardoczky GI, Engelman EE, et al. Airway pressure changes during one-lung ventilation. Anesth Analg, 1997, 84: 1034-1037.
  18. 18. Seymour AH, Prasad B, McKenzie RJ. Audit of double-lumen endobronchial intubation. Br J Anaesth, 2004, 93: 525-527.
  19. 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. 20. Bernard GR. Acute respiratory distress syndrome: a historical perspective. Am J Respir Crit Care Med, 2005, 172: 798-806.
  21. 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. 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. 23. Inomata S, Nishikawa T, Saito S, et al. Best PEEP during onelung ventilation. Br J Anaesth, 1997, 78: 754-756.
  24. 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. 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. 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. 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. 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. 29. Cohen E. Update on thoracic anesthesia. Revista Mexicana de Anesthesiologia, 2006, 29: S58-S61.

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