国际麻醉学与复苏杂志   2021, Issue (2): 0-0
    
不同时间暂停呼吸对胸腔镜手术单肺通气时肺萎陷的影响
王婷婷, 闻庆平1()
1.大连医科大学附属第一医院
Effects of disconnection technique at different times on lung collapse for one‑lung ventilation during thoracoscopic surgery
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摘要:

目的 探讨不同时间暂停呼吸对胸腔镜手术(video‑assisted thoracoscopic surgery, VATS)单肺通气(one‑lung ventilation, OLV)时肺萎陷的影响。 方法 择期全身麻醉下行胸腔镜下肺病损切除术患者60例,年龄18~65岁,ASA分级Ⅰ、Ⅱ级,一秒用力呼气容积(forced expiratory volume in one second, FEV1)>80%预测值。采用随机数字表法将患者分为C组(行常规OLV模式,在切开皮肤时行OLV)、D1组(在切开皮肤时断开双肺通气60 s后行OLV)、D2组(在切开胸膜时断开双肺通气60 s后行OLV),每组20例。记录胸膜打开即刻(T0)、胸膜打开5 min(T1)、胸膜打开10 min(T2)和胸膜打开20 min(T3)时的肺萎陷质量评级,记录完全肺萎陷时间、外科医师总体满意度、打开胸膜所需时间、OLV前双肺吸纯氧时间、OLV时间、手术时间、低氧血症及其他并发症发生情况。 结果 OLV期间,D1组、D2组完全肺萎陷时间较C组缩短(P<0.05),外科医师总体满意度较C组提高(P<0.05);D2组完全肺萎陷时间较D1组缩短(P<0.05),外科医师总体满意度较D1组提高(P<0.05)。3组患者术中均没有出现低氧血症或其他并发症;3组患者打开胸膜所需时间、OLV前双肺吸纯氧时间、手术时间、OLV时间差异无统计学意义(P>0.05)。与C组比较:D2组T0时肺萎陷质量评级极差、差的比例降低,评级良的比例增加(P<0.05);T1、T2时评级差的比例降低,评级良的比例增加(P<0.05);T3时评级良的比例降低,评级优的比例增加(P<0.05)。与D1组比较:D2组T0时肺萎陷质量评级极差、差的比例降低,评级良的比例增加(P<0.05);T1时评级差的比例降低,评级良的比例增加(P<0.05)。其余差异无统计学意义(P>0.05)。 结论 呼吸暂停法改善了VATS患者OLV时非通气侧的肺萎陷,此方法在切开胸膜时使用肺萎陷时间更短、外科医师总体满意度更高、OLV早期肺萎陷质量更优。

关键词: 呼吸暂停法; 肺萎陷; 单肺通气; 胸腔镜手术
Abstract:

Objective To investigate the effects of disconnection technique at different times on lung collapse for one‑lung ventilation (OLV) during video‑assisted thoracoscopic surgery (VATS). Methods A total of 60 patients, aged 18 to 65 years, American Society of Anesthesiologists (ASA)ⅠorⅡ, with forced expiratory volume in one second (FEV1)>80% of predicted value, who were scheduled for thoracoscopic pulmonary lesion resection under general anesthesia were enrolled. According to the random number table method, they were divided into three groups (n=20): group C (where conventional OLV was performed when the skin was incised), group D1 (where OLV was performed when the two‑lungs ventilation disconnected for 60 s after skin incision) and group D2 (where OLV was performed when the two‑lungs ventilation disconnected for 60 s after the pleura was incised). The quality of lung collapse was recorded immediately after (T0) and 5 min (T1), 10 min (T2), and 20 min (T3) after pleura incision. The time of complete lung collapse, the overall surgeon satisfaction, the time required to open the pleura, the time of pure oxygen inhaling into the lungs before OLV, the OLV time, the operation time, the incidence of hypoxemia and other complications were recorded. Results During OLV, the time of complete lung collapse in groups D1 and D2 was shorter than that in group C (P<0.05), and the overall surgeon satisfaction was higher than that in group C (P<0.05); and the time of complete lung collapse in group D2 was shorter than that in group D1 (P<0.05), and the overall surgeon satisfaction was higher than that in group D1 (P<0.05). No hypoxemia or other complications occurred in the three groups during operation. There were no statistical differences in the time required to open the pleura, the time of pure oxygen inhaling into the lungs before OLV, the operation time and the OLV time among three groups (P>0.05). Compared with group C, group D2 presented decreases in the proportion of extremely poor and poor lung collapse and increases in the proportion of good lung collapse at T0 (P<0.05); decreases in the proportion of poor grade and increases in the proportion of good grade at T1 and T2 (P<0.05); and decreases in the proportion of good grade and increases in the proportion of excellent grade at T3 (P<0.05). Compared with group D1, group D2 showed decreases in the proportion of extremely poor and poor lung collapse and increases in the proportion of good lung collapse at T0 (P<0.05); and decreases in the proportion of poor grade and increases in the proportion of good grade at T1 (P<0.05). The other differences were not statistically significant (P>0.05). Conclusions Disconnection technique improves the collapse of the non‑ventilated lung in VATS patients during OLV, which can achieve shorter lung collapse time during pleura incision, higher overall surgeon satisfaction, and better quality of lung collapse in the early stage of OLV.

Key words: Disconnection technique; Lung collapse; One‑lung ventilation; Video‑assisted thoracoscopic surgery