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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48~73(60±13)岁,体质量48~73 kg]和双肺通气组[T组,n=30,男性24例,女性6例,年龄44~74(58±16)岁,体质量50~71 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(T2~T4):2组Qs/Qt较T1时明显增高(P<0.05),PaO_2/ FiO_2较T1明显降低(P<0.05),Pa CO2明显升高(P<0.05)。组间比较:T2~T4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),PaO_2、PaO_2/ FiO_2[(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 dual ventilation on intrapulmonary shunt and oxygenation in patients undergoing thoraco-abdominal esophagectomy with artificial pneumothorax. Methods A total of 60 patients with thoraco-abdominal esophagectomy who had undergone thoracotomy for esophagectomy underwent thoracic surgery from January 2015 to January 2015 were randomly divided into one lung ventilation group (O group, n = 30, 26 males, 4, aged 48-73 (60 ± 13) years old and body weight 48-73 kg] and double lung ventilation group [T group, n = 30, 24 males and 6 females, aged 44-74 ) Years old, body mass 50 ~ 71 kg]. Both groups received double-lumen bronchial intubation, and blood gas of radial artery and right atrial blood were collected before surgery (T1), artificial pneumothorax 20 (T2), 40 (T3), 60 min (T4) and operation (T5) Analysis and calculation of intrapulmonary shunt fraction (Qs / Qt) and oxygenation index (Pa O2 / Fi O2). At the same time monitoring, contrast hemodynamic indicators, intraoperative lung collapse quality. Results During the artificial pneumothorax (T2 ~ T4), the Qs / Qt of two groups were significantly higher than those of T1 (P <0.05), PaO2 / FiO2 was significantly lower than T1 (P <0.05) and Pa CO2 was significantly increased (P <0.05). Compared between two groups, the Qs / Qt of group T [(27.5 ± 8.2)%, (28.9 ± 7.8)%, (26.6 ± 6.4)%] was significantly higher than that of group O [(33.8 ± 7.5)%, (39.4 ± 8.6) (P <0.05). PaO_2, PaO_2 / FiO_2 [(202 ± 53), (215 ± 46), (223 ± 47) mm Hg] ± 40), (149 ± 54) and (157 ± 39) mm Hg, respectively (P <0.05). There was no significant difference in Pa CO2 between two groups (P> 0.05). The quality of lung collapse in O group was better than that in T group (P <0.05). Conclusions Dual lung ventilation has less effect on pulmonary shunt in patients undergoing thoracoscopic laparoscopic esophagectomy for radical pneumothorax compared with single lung ventilation, and oxygenation is better.