单腔气管导管行单肺通气在食管癌根治术中的应用

The Utilization of a Single-lumen Tracheal Tube during One Lung Ventilation in the Radical Correction of Esophageal Carcinoma

目的:评价用单腔气管导管行单肺通气在经左胸径路食管癌根治术中的应用。方法:选择拟行经左胸径路食管癌根治术患者60例,随机分为单腔气管导管组(A组)和双腔气管导管组(B组)各30例。患者麻醉诱导后,分别插入单腔气管导管、右双腔气管导管至一侧支气管。插管成功后接麻醉机机控呼吸。观察两组患者麻醉诱导前、气管插管前、插管定位成功后收缩压、舒张压和心率情况;记录诱导前(T1)、插管定位成功后(T2)、开胸后30min(T3)、开胸后60min(T4)、术毕(T5)时血氧饱和度(SpO2)和气道峰压值(peak);观察术中肺萎陷优良例数;记录插管次数及导管定位时间;随访术后声音嘶哑和咽喉疼痛情况。结果:两组患者诱导前和插管前血压及心率无统计学差异,插管后A组血压低于B组,心率慢于B组(P<0.05)。两组SpO_2在各时间点均无统计学差异。A组peak在T3、T4点小于B组(P<0.05),在T2、T5点与B组无统计学差异(P>0.05)。A组定位时间和一次插管成功例数长(多)于B组,术中肺萎陷优良例数两组无统计学差异,术后声音嘶哑和咽喉疼痛例数少于B组。结论:利用气管导管行单肺通气用于左侧开胸手术安全可靠,且具有经济、省时,对患者呼吸、循环影响小等优点。

Objective： To evaluate the utility of a single-lumen tracheal tube during one lung ventilation in the radical correction for esophageal carcinoma via the left chest approach. Methods： Sixty patients who underwent elective radical correction for esophageal carcinoma via the left chest approach were randomly divided into the single-lumen tracheal tube group （group A, n=30） and the double-lumen endotracheal tube group （group B, n=30）. After induction of anesthesia, the single-lumen tracheal tube and the right double-lumen endotracheal tube were inserted. Following successful intubation, breathing was controlled by a ventilator. Systolic pressure, diastolic pressure and heart rate were observed before induction of anesthesia, before tracheal intubation, and after successful positioning. SpO2 and peak airway pressure （peak） were recorded before induction （T1）, after successful intubation positioning （T2）, 30 min after thoracotomy （T3）, 60 min after thoracotomy （T4）, and at the end of surgery （T5）. The time and frequency of intubation were recorded, and the extent of lung collapse was observed. Postoperative hoarseness and throat pain were observed. Results： Blood pressure and heart rate were not significantly different between the two groups before induction and before intubation. After intubation, the blood pressure of group A was lower than that of group B and the heart rate was slower than that in the B group （P〈0.05）. The SpO2 at each time point was not significantly different between the two groups. The peak airway pressure at T3 and T4 in group A was less than that in group B （ P〈0.05）. The peak airway pressure at T2 and T5 was not significantly different when comparing the 2 groups （P〉0.05）. In group B the time was longer and the intubation was more frequent than in group A. There was no significant difference in the extent of lung collapse between the two groups. There were fewer cases with postoperative hoarseness and throat pain in group A than in group B. Conclusion： The use of a single-lumen tracheal tube during one lung ventilation in the left chest approach is safe, reliable, time-saving, economical, and it has a smaller influence on breathing and circulation than traditional methods.