胸腔镜下脊柱前路手术的麻醉探讨

The Discussion of Anesthesia of Spinal Surgery Through Anterior Approach with Video-assisted Thoracoscopic Surgery

目的:探讨胸腔镜下脊柱前路手术麻醉方法的选择及术中处理。方法:胸腔镜下脊柱前路手术42例。T10以上脊柱病变选择双腔支气管插管10例,常规气管插管32例。本组病例术前进行等容量血液稀释,术中采用控制性降压,预计术中出血量较大。应用血液回收机进行自体血回收。结果:T10以上平面脊柱病变选择双腔支气管插管,进行单肺通气,术中充分暴露手术野,缩短手术时间。而T10以下脊柱病变手术,采用常规气管插管,通过增加呼吸频率,减少肺潮气量,也能顺利完成手术。本组病例42例,输异体血只有15例,占35％。结论:胸腔镜下脊柱前路手术,T10以下平面的脊柱病变,可选择常规气管插管。术中采用控制性降压和血液回收机的应用,可以较大程度降低输血量,缓解血源的紧张,和减少输血引起的不良反应。

Objective： To explore the options of anesthesia and intraoperative management of spinal surgery through anterior approach with Video-assisted thoracoscopic surgery. Methods： There were 42 cases managed by the anterior approach with Video-assisted thoracoscopic surgery. 10 cases with spinal diseases above T,, used double-lumen endotracheal intubation, and 32 cases used normal endotracheal intubation. For all cases, isovolem ic hemodilution was used before the operations, and the controlled hypotension was used during the operations. It was predicted that much blood loss will be incurred during operation. The blood collector should be used to collect the lost blood during operations. Results： The cases with spinal diseases above T10 undergoing double-lumen endotracheal intubation, single-lung ventilation had a clearer operative vision and shorter operative time. Whereas for the case under T10 all operations can also be performed successfully with normal endotracheal intubation, which is to increase the respiratory rate and reduce tidal volume of lung. In this group of 42 cases, only 15 cases used heterogenous blood transfusion, which is 35%. Conclusion：For spinal diseases under T10 undergoing spinal surgery through anterior approach with Video-assisted thoracoscopic surgery, normal endotracheal intubation can be applied. The application of controlled hypotension and blood collector during operation can reduce the heterogenous blood transfusion substantially and the complications of transfusion, and it can help to solve the problem of shortage of blood reserve as well.