摘要
目的 评价小潮气量快频率双肺通气辅以二氧化碳气胸用于胸腔镜食管癌根治术患者气道管理的效果.方法 择期行胸腔镜食管癌根治术患者30例,性别不限,年龄48～ 64岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法将其分为2组（n=15）：单肺通气组（O组）和双肺通气组（T组）.O组经口插入左侧双腔支气管导管,T组经口插入单腔支气管导管,胸腔镜操作期间,O组采用左侧单肺通气,潮气量8 ml/kg,通气频率14次/min;T组持续人工二氧化碳气胸,二氧化碳压力为10mmHg,采用双肺通气,潮气量5 ml/kg,通气频率20次/min.于麻醉诱导前（T0）、插管后即刻（T1）、插管后10 min（T2）、胸腔镜操作开始30 min（T3）、胸腔镜操作结束即刻（T4）和胸腔镜操作结束后常规双肺间歇正压通气30 min（T5）时记录MAP和HR;于T2、T3、T4和T5时行动脉血气分析;记录术野暴露情况和左侧喉返神经链淋巴结的清扫个数;记录苏醒时间、拔除气管导管时间和意识恢复时间.结果 与T2时比较,2组T34时PaO2降低,T组PaCO2升高,pH值降低（P＜0.05）;与O组比较,T组T3,4时PaCO2升高,pH值降低,左侧喉返神经链淋巴结的清扫个数增加（P＜0.05）,2组术野暴露程度、苏醒时间、拔除气管导管时间及意识恢复时间差异无统计学意义（P＞0.05）.结论 小潮气量快频率双肺通气辅以二氧化碳气胸可作为胸腔镜下食管癌根治术气道管理的一种可行模式.
Objective To evaluate the efficacy of high frequency two-lung ventilation （TLV） with low tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing thoracoscopic radical resection of esophagus cancer.Methods Thirty patients of both sexes,aged 48-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective thoracoscopic radical resection of esophagus cancer,were divided into 2 groups （n =15 each） using a random number table：onelung ventilation group （group O） and TLV group （group T）.A left-sided double-lumen tube was inserted orally in group O,and a single-lumen tube was placed orally in group T.During thoracoscopic surgery,the left lung was ventilated,with tidal volume 8 ml/kg and respiratory rate 14 breaths/min in group O.In group T,artificial pneumothorax was induced by continuous CO2 insufflation with CO2 pressure at 10 mmHg,and bilateral lungs were ventilated,with tidal volume 5 ml/kg and respiratory rate 20 breaths/min.Mean arterial pressure and heart rate were recorded before induction of anesthesia,immediately after intubation （T1）,at 10 min after intubation （T2）,at 30 min after the start of thoracoscopic surgery （T3）,immediately after the end of thoracoscopic surgery （T4） and at 30 min of TLV （T5）.Arterial blood samples were collected for blood gas analysis at T2,T3,T4 and T5.The exposure of the surgical field and the number of lymph node dissection in the left recurrent laryngeal nerve chain were recorded during surgery.The emergence time,extubation time and time for recovery of consciousness were recorded.Results Arterial oxygen partial pressure was significantly lower at T3,4 than at T2 in the two groups,and arterial carbon dioxide partial pressure was significantly higher,and the pH value was lower at T3,4 than at T2 in group T （P〈0.05）.Compared with group O,arterial carbon dioxide partial pressure was significantly increased,the pH value was decreased,and the number of lymph node dissection in the left recurrent laryngeal nerve chain was increased at T3,4 in group T （P〈0.05）.There were no significant differences between the two groups in the good exposure of the surgical field,emergence time,extubation time and time for recovery of consciousness （P〉0.05）.Conclusion High frequency TLV with low tidal volume when assisted by CO2 pneumothorax can serve as a feasible mode for airway management in patients undergoing thoracoscopic radical resection of esophagus cancer.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2017年第1期96-99,共4页
Chinese Journal of Anesthesiology
基金
河南省高等学校重点科研项目（15A320076）
关键词
潮气量
呼吸
人工
二氧化碳
胸腔镜
食管肿瘤
快频率
Tidal volume
Respiration,artificial
Carbon dioxide
Thoracoscope
Esophageal neoplasms
Fast frequency
