摘要
目的探讨加强型单腔气管插管联合CO2人工气胸在全腔镜食管癌根治术中应用的可行性。方法选择我院择期全腔镜食管癌根治术患者60例,术前心肺功能正常,无声音嘶哑,随机分为两组(每组30例)双腔气管插管组(D组)和加强型单腔气管插管联合CO2人工气胸组(S组)。麻醉诱导和维持方法相同,观察插管成功率及平均插管时间,插管前(T0)、人工气胸后30 min(T1)、1 h(T2)、1.5 h(T3)及恢复双肺通气后30 min(T4)、1 h(T5)血气分析(pH、PETCO2)、心率(HR)、平均动脉压(MAP)、心指数(CI),术中单肺通气呼气道峰压(Ppeak),胸腔操作时术者满意度评分,随访术后声嘶和呛咳发生率。结果两组患者在胸腔注气前后HR、MAP、CI差异无统计学意义,S组和D组pH值在T1、T2、T3时点与T0(7.39±0.03/7.41±0.04)比较降低,但T5时点恢复至正常水平,S组和D组PETCO2值在T1、T2、T3时点较T0(40.88±4.45/39.89±3.10)时点升高,但两组之间在各时点比较差异无统计学意义,单肺通气期间Ppeak值S组(27.33±1.75)低于D组(32.73±2.71),差异有统计学意义,术者满意度评分S组(8.40±1.12)高于D组(5.93±0.96),差异有统计学意义,S组术后声嘶及呛咳例数少于D组,差异有统计学意义,插管时间S组(43.13±6.19)短于D组(69.53±7.80),插管成功比例S组(30/30)高于D组(27/30),差异有统计学意义。结论加强型单腔气管插管联合CO2人工气胸用于全腔镜食管癌根治术患者循环、呼吸系统稳定,插管简单成功率高,且在术野暴露、减少术后声嘶、呛咳等方面具有一定优势。
Objective To investigate the feasibility of reinforced single lumen endotracheal tube combined with CO2 artificial pnumothorax in the totally minimally invasive esophagectomy.Methods Sixty patients who would undergo the totally minimally invasive esophagectomy in our hospital from 2014 to 2015,were divided into two groups randomly:single lumen endotracheal tube group(group S,n=30)and double lumen endotracheal tube group(group D,n=30).We collected the data,including the circulatory and respiratory values such as HR,MAP and CI,blood gas values such as pH and PETCO2 levels at different time points:before intubation(T0),thirty minutes(T1),one hour(T2),one and half hours(T3)after artificial pneumothorax,and thirty minutes(T4),one hour(T5)after two lungs ventilation,and P peak values during one lung ventilation.We then compared the two groups in terms of the success rate of intubation,average intubation time satisfaction level of the doctor,incidence of postoperative hoarseness and cough.Results At the time point of T0,there was no statistical significance between the two groups in terms of HR,MAP and CI at other time points.Compared with T0(7.39±0.03/7.41±0.04),pH values decreased at T1,T2,and T3,but increased to normal level at T5 in both groups.Compared with T0(40.88±4.45/39.89±3.10),PETCO2 values increased at T1,T2 and T3,but decreased to normal level at T5.The levels of pH and PETCO2 showed no statistically significant difference at the time points between the two groups.The Ppeak value was lower in group S(27.33±1.75)then group D(32.73±2.71).The doctor satisfaction score was higher in group S(8.40±1.12)then group D(5.93±0.96).The ratio of postoperative hoarseness and dysdipsia of group S was lower than group D.The average intubation time was shorter in group S(43.13±6.19)than in group D(69.53±7.80)and the one-time success rate of intubation was higher in group S then in group D in one time.Conclusion The intubation with reinforced single lumen tube combined with CO2 artificial pneumothorax can be safely used in the patients who will undergo totally minimally invasive esophagectomy according to the circulatory system and respiratory system.This method has certain advantages,such as higher success rate and simplicity at intubation,lower rate of postoperative hoarseness and dysdipsia,higher doctor satisfaction level.
作者
李伟靖
仝彤
王勇
郝晓光
邢玉英
徐红萌
LI Weijing;TONG Tong;WANG Yong;HAO Xiaoguang;XING Yuying;XU Hongmeng(Department of Anesthesiology,the Fourth Hospital,Hebei Medical University,Shijiazhuang 050035,China)
出处
《实用医学杂志》
CAS
北大核心
2018年第17期2896-2899,共4页
The Journal of Practical Medicine
基金
河北省卫生厅医学研究重点课题(编号:20150317)
河北省普通高等学校强势特色学科经费资助项目(编号:2005-52)
关键词
单腔气管插管
人工气胸
二氧化碳
intubation with single lumen tube
artificial pneumothorax
CO2
