单腔气管插管二氧化碳人工气胸法应用于胸腹腔镜食管癌根治术的安全性研究

Feasibility and safety of single-lumen endotracheal intubation and continuous carbon dioxide insufflation in thoracoscopic and laparoscopic esophagectomy for esophageal cancer

目的观察单腔气管插管、二氧化碳(CO2)持续吹入人工气胸在胸腹腔镜食管癌切除术中对呼吸、循环的影响,评价其安全性及可行性。方法对40例ASAⅡ～Ⅲ级拟行胸腹腔镜联合食管癌根治术患者的临床资料进行前瞻性分析。采用单腔气管插管,在中速充气(6～8 L/min)维持胸内压6～8 mmHg﹙1 mmHg=0.133kPa)的条件下,监测心率、平均动脉压(MAP)、中心静脉压(CVP)、脉搏血氧饱合度(SpO2)、气道压(Paw)及呼气末CO2分压(PETCO2)等呼吸、循环指标和血气指标,观察其在CO2充气前、后的变化,采集在4个时间节点的参数,分别为气管插管后20 min(T1)、人工气胸后20 min(T2)、人工气胸后60 min(T3)、人工气胸结束10 min(T4),同时采集动脉血气标本检测。结果 CO2吹入造成人工气胸后,CVP、Paw、PETCO2及PaCO2明显升高,动脉氧分压(PaO2)和血气pH值明显下降,MAP、HR和SpO2无明显变化。手术结束停止充气后,大多数指标恢复至基础值水平。所有病例均顺利完成胸腔镜手术,无严重并发症发生。结论单腔气管插管CO2吹入人工气胸时血流动力学基本稳定,生理指标在可接受的范围内,可应用于食管癌根治等复杂且耗时的胸腔镜手术。

Objective To assess the feasibility and safety of application of a single lumen endotracheal intubation and continuous carbon dioxide（CO2） insufflation in thoracoscopic and laparoscopic esophagectomy for esophageal cancer by prospectively analyzing the respiratory and circulatory effects of carbon dioxide insufflation.Methods Forty patients,who underwent a thoracoscopic and laparoscopic esophagectomy for esophageal cancer with ASA 2-3 physical classification,were included in the study.Monitoring was applied to HR,CVP,MAP,SpO2,airway pressure,PETCO2,pH,PaCO2 under the maintenance of intrapleural pressure at 6-8 mmHg（1 mmHg=0.133 kPa） and insufflation velocity 6-8 L/min.Measurements were recorded at four time points,i.e.20 minutes after intubation（T1）,20 minutes after CO2 insufflation（T2）,60 minutes after CO2 insufflation（T3）,10 minutes after CO2 insufflation ends（T4）.Samples of arterial blood gases were obtained at the same time.Results During CO2 insufflation,HR,CVP,Paw（airway pressure）,PETCO2,pH,PaCO2 increased,and pH value and PO2 decreased.There were no significant changes in MAP and SpO2 after insufflations.Operations were completely successfully in all cases without severe complications.Conclusion Single-lumen endotracheal intubation and continuous CO2 insufflation in thoracoscopic and laparoscopic esophagectomy for esophageal cancer is technically feasible and safe.