【摘要】 目的 通過觀察單肺通氣患者術中氧合指數（oxygenation index，OI）、呼吸指數（respiratory index，RI）及動態肺順應性（dynamic lung compliance，Cdyn）的變化，探討高滲氯化鈉溶液對術中單肺通氣患者的肺保護作用。 方法 選擇2009年12月-2011年2月完成的美國麻醉師協會分級為Ⅰ~Ⅲ級，心肺功能篩查、血常規、肝腎功能及凝血功能無明顯異常，擬在全麻雙腔氣管插管下行開胸手術，術中需行單肺通氣患者60例，隨機分為高滲氯化鈉組（A組）和對照組（B組），每組30例。A組在開始單肺通氣后30 min快速輸注7.5%高滲氯化鈉溶液2 mL/kg，15 min內輸注完畢，B組輸注等量生理鹽水，分別記錄輸注前（T1）、輸注完畢時（T2）、輸注后30 min（T3）、輸注后1 h（T4）的OI、RI及Cdyn變化，并比較兩組各時間點生命體征變化。 結果 兩組患者OI、RI及Cdyn在T1、T2時差異無統計學意義（Pgt;0.05）；兩組患者不同時間點平均動脈壓、心率、脈搏血氧飽和度、中心靜脈壓、呼氣末CO2分壓比較差異無統計學意義（Pgt;0.05）；A組患者在T3、T4時的OI和Cdyn較B組明顯升高，RI明顯降低（Plt;0.05）；且A組患者在T3、T4時的OI和Cdyn較T1時明顯增高，RI明顯降低（Plt;0.05）。 結論 高滲氯化鈉溶液能改善術中單肺通氣患者的OI、RI及Cdyn，對肺功能有一定的保護作用。【Abstract】 Objective To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects. Methods Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared. Results OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (Pgt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (Pgt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (Plt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (Plt;0.05). Conclusion Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.
To investigate the computed tomography (CT) characteristics and differential diagnosis of high altitude pulmonary edema (HAPE) and COVID-19, CT findings of 52 cases of HAPE confirmed in Medical Station of Sanshili Barracks, PLA 950 Hospital from May 1, 2020 to May 30, 2020 were collected retrospectively. The size, number, location, distribution, density and morphology of the pulmonary lesions of these CT data were analyzed and compared with some already existed COVID-19 CT images which come from two files, “Radiological diagnosis of COVID-19: expert recommendation from the Chinese Society of Radiology (First edition)” and “A rapid advice guideline for the diagnosis and treatment of 2019 novel corona-virus (2019-nCoV) infected pneumonia (standard version)”. The simple or multiple ground-glass opacity (GGO) lesions are located both in the HAPE and COVID-19 at the early stage, but only the thickening of interlobular septa, called “crazy paving pattern” belongs to COVID-19. At the next period, some increased cloudy shadows are located in HAPE, while lesions of COVID-19 are more likely to develop parallel to the direction of the pleura, and some of the lesions show the bronchial inflation. At the most serious stage, both the shadows in HAPE and COVID-19 become white, but the lesions of HAPE in the right lung are more serious than that of left lung. In summary, some cloudy shadows are the feature of HAPE CT image, and “crazy paving pattern” and “pleural parallel sign” belong to the COVID-19 CT, which can be used for differential diagnosis.
