这些胸科麻醉通气应将我们需要了解

阻塞性疾病中都的的组织PEEP — 在OLV之前最常用较极低TV时，或在阻塞性疾病极低血滚中都，加用PEEP的或许不确定。最可能会的主因是快照过度加压的受阻，快照过度加压是指呼气尚未完成下一轮静音便已开始，引致来进行性氧气潴留，造成了的组织PEEP。

较差呼吸道滚 — 与VCV两者之间比，尚未证实在OLV之前最常用PCV可减小肺部损幸而或提极低碳合，但或可用于操控极低呼吸道滚和避免气滚幸而。肺部气滚幸而与呼吸道跨平台滚>35cmH2O两者之间关，因此将静音跨平台滚保持在30cmH2O以下是合理的最大限度。

碳浓度 — 为极低血滚润滑时，可不最常用能够将血碳酸钠度保持在90%以上的最较差FiO2，主因如下：

●极低FiO2可能会会引致润滑口肺部发生吸收性肺部不张，从而提高改道并减小碳合[11]。

●极低碳可能会会产生化学物质的碳自由基，但尚不清楚引致碳中都毒和急性肺部损幸而的碳浓度阈值[12]。术口肺部的复张可能会会加重这种碳化可不激，引致肾脏通透性提高和肺部泡-毛细肾脏膜水肿。因此，最常用较差FiO2来进行肺部复张需用这种妨碍[13]。

●OLV之前最常见极低碳瓜氨酸和大量碳曝露，而这其实是可以预防的[14]。虽然并不一定适当最常用纯碳来要能降较差去碳饱和风险，但OLV之前血碳酸钠度<90%的发生部将仅为5%左右[15]。如果最常用高于浓度的碳气时发生去碳饱和，可暂时提高FiO2，同时采引措施纠正去碳饱和的根源。

保护性润滑 — 与同类型主张的策略两者之间比，保护性润滑可提升外科结局，具体策略为联合高于的TV、最常用PEEP、高于的呼吸道滚和FiO2<100%。

作者：张子银 广东中都医药大学第一附属医院

概述

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