电视胸腔镜下二尖瓣置换术麻醉期呼吸管理

Respiratory management in the anesthesia of video assisted thoracoscopy mitral valve replacement

目的探讨电视胸腔镜下二尖瓣置换术的呼吸管理方法。方法风湿性心脏病患者90例,随机分成胸腔镜组(A组)和传统开胸组(B组),每组45例。采用单腔气管内插管全麻,整个手术过程A组采用减少潮气量、增加呼吸频率的改良双肺通气方法来暴露术野,结合肺保护减少肺损伤;B组行常规间歇正压通气(IPPV)完成手术。观察两种呼吸管理方法对手术、预后的影响。结果2组术野暴露满意,均无恶性心律失常、残余漏、低氧血症、高碳酸血症、肺不张及肺水肿等并发症发生。A组与B组比较,术后呼吸机辅助时间(8.2±3.1)h vs(15.5±3.4)h,P<0.01),术后胸液量(155.3±56.1)ml vs(408.8±104.2)ml,P<0.01,术后住院时间(8.1±2.2)d vs(15.6±4.2)d,P<0.01,均有显著性差异。结论电视胸腔镜心脏手术中采用改良双肺通气与肺保护的呼吸管理方法,能取得能良好术野暴露,满足手术要求,减少术后并发症,缩短呼吸机辅助时间。

Objective To discuss the anesthesia respiratory management in video assisted thoracoscopy mitral valve replacement （MVR）. Methods Ninety patients with rheumatic heart disease performed mitral valve reptacement were randomized divided into thoracoscopic group（group A,n =45） and routine open heart group（group B,n =45）. The anaesthesia were performed through single-cavity tube in the trachea. Respiratory managements were respectively applied through decreasing ventilate and increasing breath rate or stopping breath methods to exposure the operation sits and combining with lung protection to decrease lung injury in group A and through employing routine intermittent positive pressure ventilation（IPPV） in group B. The affects on operation and prognosis in the two respiratory managements were observed. Results There were no operative death,no complications such as morbidity of remains leak, malignant arrhythmias, syndrome of low oxygen, the syndrome of high carbonic acid, the lung not open enough and the lung oedema, etc. There were no significant differences between group A and group B in the time of extracorporeal circulation, aorta cress-clamped and operation （P 〉 0. 05 ）. The respirator assisted ventilation time, the volume of drainage, the amount of blood transfusion and hospital day were significantly less in group A compared in group B（ all P 〈 0. 01 ）. Conclusions Using the proper ventilation mode to acquire adequate surgical exposure and potentiating the protection of lung reinforcing are the key factors to improve anesthesia management for video assisted thoracoscopy MVR.