摘要
目的比较双肺通气联合CO_(2)气胸与单肺通气对胸腹腔镜食管癌根治术患者血气分析及血流动力学的影响。方法将81例行胸腹腔镜食管癌根治术的患者依据术中通气方式分为单肺通气组(n=40)和双肺通气组(n=41)。单肺通气组给予双腔管单肺通气,双肺通气组实施单腔管双肺通气联合CO_(2)气胸。比较2组围术期指标、术中血气分析和血流动力学相关指标以及术后并发症发生率。结果双肺通气组术后住院时间短于单肺通气组,差异有统计学意义(P<0.05)。2组患者人工气胸建立后40 min(T_(2))、60 min(T_(3))、术毕(T_(4))时动脉血二氧化碳分压[p_(a)(CO_(2))]均高于同组人工气胸建立后20 min(T_(1)),双肺通气组T_(2)、T_(3)时p_(a)(CO_(2))高于单肺通气组;2组患者T_(2)、T_(3)、T_(4)时动脉血氧分压[p_(a)(O_(2))]均低于同组T_(1),双肺通气组T_(2)、T_(3)、T_(4)时p_(a)(O_(2))均高于单肺通气组;上述组内、组间的差异均有统计学意义(P<0.05)。2组患者T_(2)时平均动脉压(MAP)均高于同组T_(1)时,但双肺通气组T_(2)时MAP低于单肺通气组;2组患者T_(2)、T_(3)时心率(HR)均高于同组T_(1)时,且双肺通气组T_(2)、T_(3)时HR高于单肺通气组;上述组内、组间差异均有统计学意义(P<0.05)。双肺通气组术后并发症发生率为19.51%,低于单肺通气组的42.50%,差异有统计学意义(P<0.05)。结论胸腹腔镜食管癌根治术患者行双肺通气联合CO_(2)气胸较单肺通气具有明显优势,对术中呼吸、循环影响较小,术后并发症少,患者恢复更快,住院时间更短。
Objective To compare the influence of bipulmonary ventilation combined with CO_(2) pneumothorax and one lung ventilation on blood gas analysis and hemodynamics in patients with thoracolaparoscopic radical resection for esophageal cancer.Methods Eighty-one patients with thoracolaparoscopic radical resection for esophageal cancer were divided into single lung ventilation group(n=40)and bipulmonary ventilation group(n=41)according to the intraoperative ventilation methods.The single lung ventilation group was given one lung ventilation with double lumen tube,and the bipulmonary ventilation group was given bipulmonary ventilation with single lumen tube and CO_(2) pneumothorax.The perioperative indexes,intraoperative blood gas analysis,hemodynamic indexes and the incidence of postoperative complications were compared between the two groups.Results The postoperative hospital stay in the bipulmonary ventilation group was significantly shorter than that in the single lung ventilation group(P<0.05).The partial pressures of arterial carbon dioxide[p_(a)(CO_(2))at 40 min(T_(2)),60 min(T_(3))]after establishment of artificial pneumothorax and the end of surgery(T_(4))in both groups were significantly higher than those at 20 min after establishment of artificial pneumothorax(T_(1))in the same group(P<0.05),and the levels of p_(a)(CO_(2))at T_(2) and T_(3) in the bipulmonary ventilation group was significantly higher than that in the single lung ventilation group(P<0.05);the partial pressures of arterial oxygen[pa(O_(2))]at T_(2),T_(3) and T_(4) in both groups were significantly lower than those at T_(1) in the same group(P<0.05),and the levels of p_(a)(O_(2))at T_(2),T_(3) and T_(4) in the bipulmonary ventilation group were significantly higher than those in the single lung ventilation group(P<0.05).The mean arterial pressures(MAP)at T_(2) in both groups were significantly higher than that at T_(1) in the same group(P<0.05),but the MAP at T_(2) in the bipulmonary ventilation group was significantly lower than that in the sing
作者
孙清超
程虎
宗亮
张力为
SUN Qingchao;CHENG Hu;ZONG Liang;ZHANG Liwei(Department of Thoracic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830054;Department of Anesthesiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830054)
出处
《实用临床医药杂志》
CAS
2022年第1期67-70,共4页
Journal of Clinical Medicine in Practice
基金
2020年度省部共建中亚高发病成因与防治国家重点实验室食管癌研究专项立项项目(SKL-HIDCA-2020-SG3)。
关键词
机械通气
二氧化碳气胸
胸腹腔镜食管癌根治术
血气分析
血流动力学
mechanical ventilation
carbon dioxide pneumothorax
thoracolaparoscopic radical resection for esophageal cancer
blood gas analysis
hemodynamics
