胸腔镜心脏手术麻醉中应用小潮气量较快频率间歇正压通气的可行性

Anesthesia management for video assisted thoracoscopic cardiac surgery

目的评估单腔气管插管，小潮气量较快频率间歇正压通气（intermittent positive pressure ventilation，IPPV）在电视胸腔镜心脏手术麻醉中的可行性和安全性。方法回顾西京医院心脏外科2003年1月-2007年6月，132例电视胸腔镜下心脏手术的患者的麻醉和机械通气管理模式，统计分析了麻醉诱导后、建立胸腔镜系统体外循环前、体外循环后、手术结束时动脉血气结果和终末潮气CO2分压（PetCO2），进行自身对照研究。结果所有患者可以耐受单腔气管插管，小潮气量较快频率问歇正压通气下的胸腔镜手术，无麻醉相关并发症发生，胸腔镜心内手术操作期间Pet—CO2和动脉血CO2分压（PaCO2）较麻醉诱导略有升高，仍在正常范围，O2分压（PaO2）有显著降低（P〈0．05），也在正常范围，手术结束时均恢复到正常。结论单腔气管插管可适用于1岁以上先天性心脏病患者的胸腔镜手术。

AIM To assess the feasibility and safety of small tidal volume and high frequency intermittent positive pressure ventilation （IPPV） with single lumen endotracheal tube （SLET） during the anesthesia for video assisted thoracoscopic cardiac operation. METHODS One hundred and thirty two patients, who had undergone video assisted thoracoscopic cardiac operations between 2003 and June 2007, were reviewed. Small tidal volume and high frequency IPPV with SLET was performed in all the patients during thoracoscopic cardiac operation. The arterial blood gas analysis results and PetCO2 at the time points of anesthetic induction, before the cardiopulmonary bypass （CPB） setup, after the weaning of CPB and at the end of the operation were statistically analyzed. RESULTS The anesthesia strategy was tolerated by all the patients during the operation without any anesthesia related complications. The values of PetCO2 and PaCO2 before and at the end of CPB were slightly higher than the values after anesthesia induction and at the end of operation without statistical significance. But the values of PaO2 before and at the end of CPB were much lower than the values after anesthesia induction and at the end of operation （ P 〈 0.05 ）. CONCLUTION Small tidal volume and high frequency IPPV with SLET can be safely used in the anesthesia for video assisted thoracoscopic cardiac surgery in patients older than 1 year old.