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| 二氧化碳人工气胸与支气管封堵器用于胸腹腔镜食管癌根治术的比较 |
| Comparison between carbon-dioxide artificial pneumothorax and endobronchial blocker in thoracolaparoscopic esophagectomy |
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| DOI：10.12089/jca.2019.10.005 |
| 中文关键词: 食管癌 单肺通气 支气管封堵器 二氧化碳人工气胸 |
| 英文关键词: Esophageal cancer One-lung ventilation Bronchial blocker Carbon-dioxide artificial pneumothorax |
| 基金项目: |
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| 中文摘要: |
目的 比较二氧化碳人工气胸双肺通气和支气管封堵器单肺通气对胸腹腔镜食管癌根治术患者的影响。
方法 胸腹腔镜食管癌根治术患者97例,男62例,女35例,年龄50～75岁,BMI 18～29 kg／m2,ASA Ⅰ或Ⅱ级,随机分为两组:二氧化碳人工气胸双肺通气组(AP组, n=50)和支气管封堵器单肺通气组(BB组, n=47)。记录拔管时间和胸腔操作开始后15 min肺萎陷评分。记录胸腔操作前双肺通气时(T0)、胸腔操作开始后10 min(T1)、30 min(T2)、60 min(T3)和胸腔操作结束后10 min(T4)的MAP、CVP、气道峰压（Ppeak）、PaO2、PaCO2,计算死腔率(VD／VT)和分流率(Qs／Qt),同时记录甲氧明推注例数和去甲肾上腺素泵注例数和新发心律失常例数。术中提取食管肌层组织RNA后检测一氧化氮合酶3基因(NOS3)的转录水平。记录术后并发症的发生情况。
结果 BB组拔管时间明显短于AP组(P＜0.05),肺萎陷评分明显低于AP组(P＜0.05)。T1—T3时AP组MAP明显低于BB组(P＜0.05),CVP明显高于BB组(P＜0.05)。T2—T4时AP组PaCO2明显高于BB组(P＜0.05)。T1—T3时AP组VD／VT明显高于BB组(P＜0.05)。AP组甲氧明推注例数、去甲肾上腺素泵注例数明显多于BB组，新发心律失常发生率明显高于BB组 (P＜0.05)。BB组NOS3的转录水平是AP组的3.48倍（P＜0.05）。两组术后并发症发生率差异无统计学意义。
结论 与二氧化碳人工气胸双肺通气比较,支气管封堵器单肺通气更有利于早期拔管和术野暴露,不失为胸腹腔镜食管癌根治术患者更好的术中气道管理方案。 |
| 英文摘要: |
Ojective To compare the effect of carbon-dioxide artificial pneumothorax two-lung ventilation and endobronchial blocker one-lung ventilation on patients undergoing thoracolaparoscopic esophagectomy.
Methods Ninety-seven patients undergoing thoracolaparoscopic esophagectomy, 62 males and 35 females, aged 50-75 years, BMI 18-29 kg／m2, falling into ASA physical status Ⅰ or Ⅱ, were recruited and randomly divided into two groups: carbon-dioxide artificial pneumothorax two-lung ventilation group (group AP, n = 50) and endobronchial blocker one-lung ventilation group (group BB, n = 47). The time of extubation and the score of pulmonary collapse 15 min after the beginning of thorax operation were recorded. MAP, CVP, airway peak pressure (Ppeak), PaO2, PaCO2, dead space rate (VD／VT) and lung blood shunt rate (Qs／Qt) were recorded while two lung ventilation was administered before thoracoscopic operation (T0), 10 min (T1), 30 min (T2) and 60 min (T3) after thoracoscopic operation started and 10 min (T4) after thoracoscopic operation finished. The methoxamine consumption, the case numbers of noradrenaline administration and newly occurred arrhythmias were recorded. Total RNA was taken from the esophageal muscular tissue and transcription level of nitric oxide synthase 3 gene (NOS3) was calculated by relative quantification. Postoperative complications were also recorded.
Results The extubation time of group BB was shorter than that of group AP (P ＜ 0.05), while the lung collapse score was lower in group BB than in group AP (P ＜ 0.05). MAP in group AP was significantly lower and CVP was significantly higher than that in group BB at T1-T3(P ＜ 0.05). PaCO2 in group AP was higher than that in group BB at T2-T4(P ＜ 0.05). VD／VT in group AP was higher than that in group BB at T1-T3(P ＜ 0.05). The case numbers of methoxamine and noradrenaline administration and newly occurred arrhythmias in group AP were more than those in group BB (P ＜ 0.05). The transcription of NOS3 in group BB was 3.48 times, which was higher than that in group AP (P ＜ 0.05). There was no statistically different in the case number of postoperative complications between the two groups.
Conclusion Compared with the carbon-dioxide artificial pneumothorax two-lung ventilation, endobronchial blocker one-lung ventilation is more beneficial in early extubation and surgical field exposure and may well be a better choice of intraoperative airway management for the patients undergoing thoracolaparoscopic esophagectomy. |
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