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目的探讨新生儿食管端端吻合手术中单肺通气(OLV)麻醉的可行性和安全性。方法对20例日龄4h～17d、体重1.5～3.2kg的食管闭锁及气管食管瘘患儿,快速诱导后,在正气管插入单腔气管导管,右侧开胸,使术侧肺脏压迫萎陷造成左侧单肺通气(OLV)。术中连续监测心率(HR)、动脉压(ABP)、心电图(ECG)、脉搏血氧饱和度(SpO2)、呼气末CO2分压(PETCO2)、体温(T);记录诱导前后OLV10min、OLV30min,术毕的SpO2、PETCO2、HR值,比较各时段呼吸循环参数变化。结果全部患儿单肺通气后SpO2均有下降,经适当处理,14例患儿SpO2维持在95%以上。3例患儿应用呼气末正压通气(PEEP),可维持SpO2在94%以上。另3例患儿在暂停手术操作、恢复双肺通气后,SpO2恢复正常。与诱导后相比,PETCO2在单肺通气后10min及30min分别为(30.2±3.6)、(29.5±4.8)mmHg,显著低于诱导后的(35.1±0.6)mmH(gP<0.05)。HR在单肺通气后各时段呈显著降低趋势(P<0.05)。结论采用正气管插管技术,应用合理的呼吸管理,适当的麻醉用药,新生儿单肺通气行类似于食管端端吻合手术是安全可行的。
Objective To investigate the feasibility and safety of single lung ventilation (OLV) anesthesia in neonatal endoscopic esophageal anastomosis. Methods Twenty patients with esophageal atresia and tracheoesophageal fistula, 4 days to 17 days old and 1.5 to 3.2kg body weight, were rapidly induced. After single-lumen tracheal tube was inserted into the right trachea and thoracotomy was performed on the right side, Causes left one-lung ventilation (OLV). The heart rate (HR), arterial pressure (ABP), electrocardiogram (ECG), pulse oxygen saturation (SpO2), end-tidal CO2 partial pressure (PETCO2) and body temperature , SpO2, PETCO2 and HR after operation, and the changes of respiratory cycle parameters were compared. Results All patients with single lung ventilation after SpO2 decreased, after appropriate treatment, SpO2 in 14 patients maintained at 95%. 3 cases of children with positive end expiratory pressure (PEEP), SpO2 can be maintained at 94%. The other 3 patients had their SpO2 returned to normal after suspending the operation and resuming bilateral lung ventilation. Compared with post-induction, PETCO2 was (30.2 ± 3.6), (29.5 ± 4.8) mmHg at 10 min and 30 min after single-lung ventilation, which was significantly lower than that after induction (35.1 ± 0.6) mmH (gP <0.05). HR decreased significantly at each time point after single lung ventilation (P <0.05). Conclusions The use of positive tracheal intubation, appropriate respiratory management, appropriate anesthesia, and neonatal one-lung ventilation are similar to esophageal end-to-end anastomosis is safe and feasible.