同期双侧肺部手术的麻醉处理

Anesthetic management for bilateral simultaneous thoracic surgery

目的总结同期双侧肺部手术的麻醉经验,旨在探讨最佳麻醉方案。方法 2005年8月-2010年11月共完成同期双侧肺部手术33例,其中12例双侧肺大疱气胸患者行两侧大疱切除,8例双侧肺癌患者行两侧肺叶切除,9例一侧肺癌对侧肺结节患者行一侧肺叶切除及对侧肺部分切除,4例两肺结节患者行双肺部分切除。麻醉医师参加外科术前讨论,根据病变性质和范围、术前肺功能情况、手术计划判定双侧同期手术的可能性,依据疾病的种类及不同的手术方案,个体化确定麻醉和呼吸管理的方法。结果所有病例的麻醉均获得满意的效果。平均麻醉时间为(4.20±1.59)h,平均手术时间为(3.89±1.65)h,平均重症监护病房停留时间为(4.47±3.03)d,平均住院时间为(12.43±6.16)d。结论同期双侧肺部手术麻醉处理的关键在于依据手术种类和肺功能情况评估患者能否耐受同期手术,谨慎实施先完成手术侧的单肺通气管理。

Objective To summarize our anesthesia experience for patients undergoing double-lung operation, so as to bring forward the best scheme. Methods Thirty-three double-lung operation anesthesia was performed in our department during August 2005 to November 2010. Among them, 12 patients were with bilateral bullae undergoing bilateral bullae resection, 8 patients with bilateral lung cancer undergoing bilateral pulmonary lobectomy, and 4 patients with pulmonary nodules undergoing bilateral lung resection. We participated in the surgery discussions before operation, and individualized anesthesia scheme was determined according to lesion property, pathological involvement and pulmonary function, and discussed the possibility of bilateral surgery during corresponding period. The difference of diseases and surgery options were also concerned. Results Satisfactory anesthesia was achieved in all the cases. The average anesthesia time was （4.20±1.59） h, average operation time was （3.89±1.65） h, average time in intensive care unit was （4.47±3.03） d, and average discharge time was （12.43±6.16） d. Conclusion The key of anesthesia for patients undergoing double-lung operation is to evaluate whether the patients can tolerate bilateral lung surgery at the same time, which is based on the preoperative pulmonary function and various surgery proposal. Carefully one lung ventilation management, especially in the first operation side is essential.