摘要
目的评估暂停呼吸快速肺萎陷技术在胸腔镜手术中的应用效果。方法64例接受胸腔镜手术的患者,随机分为C组和D组,各32例。所有患者均进行左双腔管肺隔离技术,在此基础上C组患者采用传统单侧肺呼吸方式,D组患者采用暂停呼吸快速肺萎陷技术。比较两组患者平均动脉压(MAP)、心率、经皮动脉血氧饱和度(SpO_(2))、呼气末二氧化碳分压、手术相关指标(单肺通气时间、达到满意萎陷时间、完全肺萎陷时间)以及术中不同时间[胸膜开放即刻(T0)、胸膜开放2 min后(T1)、胸膜开放8 min后(T2)和胸膜开放14 min后(T3)、胸膜开放22 min后(T4)]肺萎陷质量。结果D组完全肺萎陷时间(13.75±0.93)min、达到满意萎陷时间(8.03±2.81)min以及单肺通气时间(94.17±11.05)min明显短于C组的(21.84±0.97)、(14.28±2.77)、(102.17±11.01)min,差异具有统计学意义(P<0.05)。D组中T2、T3和T4时的肺萎陷质量优良率分别为84.38%、93.75%、100.00%,明显高于C组的43.75%、59.38%、87.50%,两组之间存在显著差异(P<0.05)。D组中,与T0比较,平均动脉压T1、T2、T3、T4时趋于稳定(P>0.05),心率T2、T3和T4时升高(P<0.05),经皮血氧饱和度T1、T2、T3、T4时趋于稳定(P>0.05),呼气末二氧化碳分压T1、T2、T3、T4时升高(P<0.05);C组中,与T0比较,平均动脉压和心率T1、T2、T3、T4时趋于稳定(P>0.05),经皮血氧饱和度T1、T2、T3、T4时降低(P<0.05),呼气末二氧化碳分压T1、T2、T3、T4时趋于稳定(P>0.05)。与C组比较,D组T1、T2、T3、T4时平均动脉压趋于稳定(P>0.05),心率T1、T2、T3、T4时升高(P<0.05),经皮血氧饱和度T2、T3、T4时升高(P<0.05),呼气末二氧化碳分压T1、T2、T3、T4时升高(P<0.05)。结论胸腔镜手术患者采用暂停呼吸快速肺萎陷技术,特别是在切开胸膜时中断双肺通气120 s能够达到最好的效果,与传统单侧肺通气方法相比,可以加快肺萎陷,临床医生满意度高,可鼓励在临床实践中广泛采用。
Objective To evaluate the effect of apnea rapid lung collapse technique in thoracoscopic surgery.Methods 64 patients who underwent thoracoscopic surgery were randomly divided into group C and group D,with 32 cases in each group.All patients underwent left-sided double-lumen tracheal intubation.On this basis,patients in group C underwent traditional single-lung ventilation,and patients in group D underwent apnea rapid lung collapse technique.Comparison was made on mean arterial pressure(MAP),heart rate,percutaneous oxygen saturation(SpO_(2)),end-tidal partial pressure of carbon dioxide,operation-related indicators(time of single lung ventilation,time of satisfactory collapse,time of complete lung collapse)and lung collapse quality at different times during surgery[immediately after pleura opening(T0),2 min after pleura opening(T1),and 8 min after pleura opening(T2),14 min after pleural opening(T3),22 min after pleural opening(T4)]between the two groups.Results The time of complete lung collapse in group D was(13.75±0.93)min,the time of satisfactory collapse was(8.03±2.81)min and the time of single lung ventilation was(94.17±11.05)min,which were significantly shorter than(21.84±0.97),(14.28±2.77)and(102.17±11.01)min in group C,and the difference was statistically significant(P<0.05).The excellent and good rates of lung collapse quality at T2,T3 and T4 were 84.38%,93.75%and 100.00%in group D,which were significantly higher than 43.75%,59.38%and 87.50%in group C,and there was a significant difference between the two groups(P<0.05).In group D,compared with T0,mean arterial pressure tended to be stable at T1,T2,T3 and T4(P>0.05),the heart rate increased at T2,T3 and T4(P<0.05),the percutaneous oxygen saturation tended to be stable at T1,T2,T3 and T4(P>0.05),and the endtidal partial pressure of carbon dioxide increased at T1,T2,T3 and T4(P<0.05).In group C,compared with T0,the mean arterial pressure and heart rate tended to be stable at T1,T2,T3 and T4(P>0.05),the percutaneous oxygen saturation decreased at T1,T2,T3 and T4(P<0.05),and the end-tidal partial pressure of carbon dioxide tended to be stable at T1,T2,T3 and T4(P>0.05).Compared with group C,the mean arterial pressure in group D tended to be stable at T1,T2,T3 and T4(P>0.05),the heart rate increased at T1,T2,T3 and T4(P<0.05),the percutaneous oxygen saturation increased at T2,T3 and T4(P<0.05),and the end-tidal partial pressure of carbon dioxide increased at T1,T2,T3 and T4(P<0.05).Conclusion The use of apnea rapid lung collapse technique in thoracoscopic surgery can achieve the best results,especially the interruption of double lung ventilation for 120 s during pleura opening.Compared with traditional unilateral lung ventilation method,it can accelerate lung collapse,and clinicians'satisfaction is high,which can encourage widespread adoption in clinical practice.
作者
贺增举
李晶
孔明健
HE Zeng-ju;LI Jing;KONG Ming-jian(Xuzhou Mining Group General Hospital,Xuzhou 221006,China)
出处
《中国现代药物应用》
2024年第4期12-15,共4页
Chinese Journal of Modern Drug Application
关键词
胸腔镜手术
单肺通气
快速肺萎陷技术
血氧饱和度
肺萎陷评分
Thoracoscopic surgery
Ventilation of the single lung
Rapid lung collapse technique
Oxygen saturation of the blood
Lung collapse score
