结核毁损肺单侧全肺切除的麻醉处理

The Anesthesia in Unilateral Pneumonectomy for Destructed Pulmonary Function of Tuberculosis

目的 探讨结核毁损肺单侧全肺切除的麻醉处理。 方法 80例结核毁损肺行单侧全肺切除病人 ,术前肺功能减损轻度者 30例 (G组 ) ,中度者 35例 (M组 ) ,重度者 15例 (S组 )。 5 6例行左侧全肺切除 :4 4例使用双腔支气管导管 (Carlon管 10例、White管 2 0例、左侧Robertshaw管 8例、右侧Robertshaw管 6例 )、右单腔支气管导管 7例、气管导管 5例。2 4例行右侧全肺切除 :2 1例使用双腔支气管导管 (Carlon管 19例、左侧Robertshaw管 2例 )、左单腔支气管导管 2例、气管导管 1例。痰量 >5 0ml/d的 16例病人中 ,采用双腔支气管导管 7例、右单腔支气管导管 7例、左单腔支气管导管 2例。 结果 G组、M组未发生围手术期并发症 ,S组术后发生急性呼吸衰竭 5例 (33.33% )。痰量 >5 0ml/d的病人中 ,2例使用左单腔支气管导管的病人术后均发生健侧支气管病灶播散 ;而使用双腔支气管导管和右单腔支气管导管未发生结核播散。 结论 结核毁损肺重度肺功能减损者 ,术前FEV1占预计值的百分比 <35 % ,MVV占预计值的百分比 <4 0 % ,行单侧全肺切除手术要慎重。术前痰量 >5 0ml/d的病人 ,应选择双腔支气管导管或右单腔支气管导管 ,确保两肺分隔满意 ,以防止术后健侧支气管病灶播散。

Objective To discuss the anesthesia management of unilateral pneumonectomy for the destructed pulmonary function of tuberculosis. Method The distory of pulmonary function were valued in 80 patients, with 30 cases of gentleness (G group), 35 cases of middle (M group), and 15 cases of severity (S group). They all underwent unilateral pneumonectomy with 56 in left and 24 in right. In the left lung surgery group, tracheal catheters were used with bronchial double-lumen tube in 44 (10 Carlon, 20 White, 8 left Robertahaw, 6 right Robertahaw), right bronchial one-lumen tube in 7 and tracheal tube in 5. In the right lung surgery group, tracheal catheters were used with bronchial double-lumen tubes in 21, right brochial one-lumen tube in 2, and tracheal tube in 1. In 16 cases with sputum more than 50 ml per day, tracheal intubation was performed with double-lumen tube in 7, right single-lumen tube in 7 and left single-lumen tube in 2. Result There was no complication in G and M group during perioperative period. Acute pulmonary function failure occurred in 5 cases (33.3%) in S group after operation. In the 16 patients with sputum amount more than 50 ml per day, all the two cases used the left single-lumen tube got the lung infected in health side, but there was no infection in others. Conclusion It must be serious to perform unilateral pulmonectomy for sever distoried function of pulmonary tuberculosis with FEV 1 less than 35% and MVV less than 40%. Double-lumen bronchial tube or right single-lumen bronchial is the necessory selection to keep the two sides of lung seperated and prevent the health side from infecting tubercnlosis for the patients with sputum amount more than 50 ml per day.