摘要背景 在胸科手术的麻醉中进行单肺通气(one-lung ventilation,OLV),不但可以为手术提供良好的术野,而且可以隔离并保护肺脏.但是,这是一种非生理状态下的通气方式,OLV期间的气压伤和氧毒性等因素常导致机械通气相关性肺损伤(ventilator-induced lung injury,VILI). 目的 探讨适合胸科手术的OLV策略. 内容 在OLV期间,采用肺泡复苏策略(alveolar recruitment strategy,ARS)和“小潮气量+呼气末正压通气(positive end-expiratory pressure,PEEP)”的保护性通气策略,使吸气平台压(plateau pressure,Pplat)＜25 cmH2O(1 cmH2O=0.098 kPa)和气道峰压(peak inspiratory pressure,Ppeak)＜35 cmH2O;限制FiO2;依据动脉血气分析的结果,酌情调整呼吸频率. 趋向 在OLV期间,应避免肺泡的过度膨胀和循环性的萎陷-复张,避免高浓度氧导致氧化应激加重,可以接受短时间内的高碳酸血症.对患者进行个体化管理,降低ICU的入住率及住院时间,提高患者的生存率及生存质量.

abstractsBackground One-lung ventilation(OLV) can provide optimum surgical operating conditions and isolate the lungs to protect them during anesthesia for thoracic surgery.Unfortunately,OLV is a way of ventilation under the non-physiological condition.During the OLV,it often leads to ventilator-induced lung injury(VILI) as a result of barotraumas,oxygen toxicity,and so on.Objective Investigate the preferable strategy of one-lung ventilation for thoracic surgery.Content An alveolar recruitment strategy(ARS) and the lung protective ventilation strategy using low-tidal volumes and the appropriate positive end-expiratory pressure (PEEP) would limit plateau and peak inspiratory pressures (Pplat and Ppeak) to 25 cmH2O (1 cmH2O=0.098 kPa) and 35 cmH2O,respectively.FiO2 should be limited,too.According to the arterial blood gas analysis,respiration rate can be adjusted properly.Trend For the non-operated lung,it can avoid alveolar over-inflation and cyclic recruitment-derecruitment during the OLV.High FiO2 would aggravate oxidative stress,so it is wise to limit FiO2 during OLV.Also,hypercapnia is well tolerated in the short term.Individualized management of patients would create fewer admissions to the intensive care unit and a shorter hospital stay,and improve survival rates and quality of life of them.