摘要
目的 观察单肺或双肺通气对人工气胸下行胸腹镜食管癌根治术患者肺内分流率和氧合的影响。方法 筛选2015年1-12月我院胸外科60例人工气胸下行胸腹镜食管癌根治术患者,采用随机数字表法分为单肺通气组[O组,n=30,男性26例,女性4例,年龄4873（60±13）岁,体质量4873 kg]和双肺通气组[T组,n=30,男性24例,女性6例,年龄4474（58±16）岁,体质量5071 kg]。2组均行双腔支气管插管,在术前（T1）,人工气胸20（T2）、40（T3）、60 min（T4）及术毕（T5）采集桡动脉血和右心房血进行血气分析,计算肺内分流率（intrapulmonary shunt fraction,Qs/Qt）及氧合指数（Pa O2/Fi O2）。同时监测、对比血流动力学指标,术中肺萎陷质量。结果 人工气胸期间（T2T4）：2组Qs/Qt较T1时明显增高（P〈0.05）,PaO2/ FiO2较T1明显降低（P〈0.05）,Pa CO2明显升高（P〈0.05）。组间比较：T2T4时T组Qs/Qt[（27.5±8.2）%、（28.9±7.8）%、（26.6±6.4）%]较O组[（33.8±7.5）%、（39.4±8.6）%、（36.1±7.1）%]明显降低（P〈0.05）,PaO2、PaO2/ FiO2[（202±53）、（215±46）、（223±47）mm Hg]较O组[（161±40）、（149±54）、（157±39）mm Hg]升高（P〈0.05）,Pa CO2差异无统计学意义（P〉0.05）。O组肺萎陷质量较T组好（P〈0.05）。结论 双肺通气较单肺通气对人工气胸下胸腹腔镜食管癌根治术患者肺内分流影响较小,氧合更好。
Objective To observe the effects of single or double lung ventilation on intrapulmonary shunt fraction and oxygenation in esophageal cancer patients treated with thoraco-laparoscopic esophagectomy under artificial pneumothorax. Methods Sixty esophageal cancer patients who underwent thoracolaparoscopic esophagectomy under artificial pneumothorax in the department of thoracic surgery of our hospital from January to December 2015 were randomly divided into single （O） and double （T） groups, with each group of 30 cases. The O group （26 males and 4 females） aged from 48 to 73 years （mean 60 - 13 years）, and weighted 48 -73 kg. The T group （24 males and 6 females ） were 44 -74 years old （mean 58 ± 16 years）, with a weight ranging from 50 to 71 kg. All the patients were anesthetized by double lumen endotracheal intubation. Blood gas analysis was measured from radial artery blood and right atrium blood before operation （ T1 ）, in 20 rain （ T2 ）, 40 rain （ T3 ） and 60 min （ T4 ） under the procedure of artificial pneumothorax, and at the end of operation（ T5 ）. The intrapulmonary shunt fraction（Qs/Qt） and oxygenation index（ PaOJFiO2 ）were calculated. The hemodynamic parameters and quality of lung collapse were recorded. Results The blood gas analysis showed that in both groups, Qs/Qt and PaCO2 were significantly increased （P 〈 0. 05 ） and PaO2/FiO2 were significantly decreased （ P 〈 0. 05 ） in the artificial pneumothorax T2 - T4compared with in T1. No significant difference of Qs/Qt,PaO2,PaO2/FiO2 and PaCO2 was found between the 2 groups at T1 and T5 （P 〉 0. 05）. At T2, T3, and T4, Qs/Qt values for T group were 27.5 ± 8.2, 28.9 ± 7.8 and 26.6 ± 6.4, which were significantly lower than the corresponding Qs/Qt values （ 33.8 ± 7.5, 39.4 ± 8.6 and 36.1 ±7.1 ） in O group （P 〈 0. 05 ）. Also, PaO2 and PaO2/FiO2 at T2, T3 and T4 were significantly higher in the T group（202 ±53, 215 ±46, 223 ±47） compared with in the O group（ 161 ±40, 14
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2016年第24期2629-2633,共5页
Journal of Third Military Medical University
基金
重庆市卫生局医学科学技术研究基金资助面上项目(2011-2-361)~~
关键词
单肺或双肺通气
人工气胸
胸腹腔镜
肺内分流率
氧合指数
single or double lung ventilation
artificial pneumothorax
thoracoscopy and laparoscopy
intrapulmonary shunt fraction
oxygenation index
