Objective To explore the application value of selective lobe isolation in thoracotomy for thoracic vertebral tuberculosis.
Methods Forty-eight patients (30 male, 18 female) who experienced right thoracotomy for vertebral tuberculosis lesion removal plus internal fixation from August, 2016 to March, 2018 were enrolled, aged 31 - 65 years, BMI of 18-27 kg /m2 and ASA Ⅱ or Ⅲ. They were randomly divided into bronchus blocker group (group E) and double-lumen bronchial tube group (group D), 24 patients in each group. After anesthesia induction in the two groups, the single - lumen bronchial tube was inserted, and the bronchus blocker was placed under the guidance of fiberoptic bronchoscopy for group E; the double - lumen bronchial tube was placed for group D. During surgery, pure oxygen inhalation with oxygen flow of 3 L/min and volume limited-pressure control ventilation mode were applied; during two - lung ventilation, VT 8 - 10 ml/kg, RR 10 - 14 times/min, and I∶E 1∶ 1.5 were applied; during one-lung ventilation (OLV), VT 7 ml/kg, RR 12 - 16 beats/min, I∶E 1∶1.5 were applied. Airway peak pressure (Ppeak), platform pressure (Pplat), and dynamic chest lung compliance (Cdyn) were recorded at 5 min before OLV (T0), 30 min after OLV (T1), 5 min after chest closure and lung ventilation (T2). Arterial blood and central venous blood were collected at T1, T2, and 18 h after operation (T3), respectively, and pH, PaCO2 were recorded, followed by calculation of the Qs/Qt and oxygenation index (OI). The concentrations of interleukin - 6 (IL - 6) and tumor necrosis factor-α (TNF-α) in bronchoalveolar lavage fluid were detected by enzyme linked immunosorbent assay at T0 and T3, and postoperative sore throat or hoarseness was recorded. The respiratory and circulatory complications were assessed 7 days after operation.
Results At T1, Pplat and Ppeak in group E were significantly lower than in group D, and Cdyn in group E was significantly higher than in group D (P < 0.05). At T2 and T3, pH in group E were significantly higher than in group D (P < 0.05); at T1 and T3, PaCO2 in group E was significantly lower than in group D (P < 0.05), and OI in group E was significantly higher than in group D (P < 0.05). After operation, the TNF-a and IL-6 of group E were significantly lower than in group D (P < 0.05). After operation the pharyngeal pain and hoarseness in the group E were lower than in group D after operation (P < 0.05).
Conclusion Selective lung lobe isolation during thoracotomy for thoracic vertebral tuberculosis can better reduce airway pressure under OLV, improve Cdyn, OI, and reduce PaCO2, maintaining the acid-base balance of the internal environment so as to reduce lung injury. Selective lung lobe isolation can also reduce postoperative sore throat or hoarseness. |
