电视胸腔镜手术的麻醉处理

Anesthesia and management for video assisted thoracoscopic surgery

目的 探讨对电视胸腔镜手术 (VATS)的病人采用双腔管气管插管行单肺通气时对 Sp O2 和 PETCO2 的影响及麻醉管理。方法 30例进行 VATS病人行双腔管气管插管全麻 ,单肺通气 (OL V) ,VT8～ 10 m l/ kg,RR14～ 16次 /分 ,术中监测 Sp O2 、 PETCO2 、 MAP、 HR等。结果 Sp O2 在 OL V 15 min时比 TL V时显著下降 (从 99.99± 0 .0 1降至 97.77± 3.18,P <0 .0 1) ,以后逐渐回升。 3例病人 Sp O2 <90 % ,经处理后 Sp O2 回升。 PETCO2 在 OL V 15 min时比 TL V时显著升高 [从(4.16± 0 .15 ) k Pa升至 (4.95± 0 .46 ) k Pa,P <0 .0 1],但在正常范围。结论 施行双腔管插管行 OL V麻醉的 VATS由于病人肺内分流 (Qs/ Qt)增加 ,使 Pa O2 降低 ,麻醉中要注意 Sp O2 的监测 ,必要时采取增加通气量 ,非通气肺行 HFV等措施提高 Pa O2 。

Objective \ To investigate effect of double lumen endobronchial tube and one lung ventilation anesthesia to SpO\-2、P\-\{ET\}CO\-2 and management for patients who undergoing video assisted thoracoscopic surgery (VATS) Methods\ Thirty patients undergoing VATS were anesthetized with double lumen endobronchial tube and one lung ventilation (OLV) V\-T8~10ml/kg, RR14~16 breaths/min Patients were monitored SpO\-2、MAP、 HP、P\-\{ET\}CO\-2 during anesthesia Results\ PaO\-2 was lower at 15min following OLV than that at 15min following TLV(form 99 99±0 01 to 97 77±3 38,P<0 01) Then SpO\-2 rose gradually SpO\-2 of 3 patients was less than 90% and rose by treatment P\-\{ET\}CO\-2 was higher at 15min following OLV than that at 15min following TLV[from (4 16±0 51)kPa to (4 96±0 46)kPa,P<0 01] But rang of P\-\{ET\}CO\-2 was normally Conclusion\ Qs/Qt of patients who undergoing VATS increase during double lumen endobronchial tube and OLV anesthesia PaO\-2 of patients decrease Monitoring SpO\-2 is important during OLV anesthesia There is necessary to improve oxygenation with some methods in hypoxemia \ \