胸内气管手术中气管插管和肺通气方式的选择

Selection of modes of indubation and ventilion in the intratrachea operation

目的 探讨胸内气管、隆突、支气管手术中气管插管和肺通气方式的选择。方法 ①气管插管：根据手术部位不同选择经口和经术野两次插管法、双腔管和单腔管插管法。②肺通气方式：气管、支气管离断吻合期间选择单肺通气、双肺通气和双肺分别通气方法。连续监测MAP、HR、EKG、SpO2和PetCO2, 于麻醉前、诱导毕、气管支气管离断和呼吸道重建时查动脉血气。结果 30例胸内气管、隆突和支气管手术选择两次插管法8例、双腔管14例、单腔管8例。气管支气管离断时，单肺通气25例、双肺通气2例、双肺分别通气3例。监测MAP、HR、EKG 、PaO2、PaCO2、SpO2和PetCO2变化均在正常范围。结论 胸内气管、隆突、支气管手术中，3种不同方式的气管插管和肺通气能有效建立和维护呼吸道通畅；3种不同的肺通气方式能满足各部位通气需求，其中单肺通气最为常用，而双肺通气和双肺分别通气更接近生理状态。

Objective To study the option of modes of ventilation in patients undergoing the operations of tracheal, carinal and broncheal resection, and tracheobronchial reconstruction. Methods ① endotracheal intubation: according to differences of the operation site, selecting or otracheal tube, endobronchial tube or cuffed endotracheal tube through the surgi cal field. ② modes of ventilation: during the period of tracheal transection and anastomosis selecting one-lung, two-lungs ventilation or two lungs ventilation respectively. Continuously monitoring MAP, HR and EKG perioperatively and performing arterial blood gas analysis prior to anesthesia, after induction, during the period of tracheal and carinal resection, and the period of tracheobronchial reconstruction. The average value was obtained by mean value standard devi ation （x±s）. t test was used in groups (P<0.05 meaning significant difference). Results Anesthesia was performed for 30 cases undergoing the operations of tracheal, broncheal and carinal resection, and tracheobronchial reconstruction: 8 cases for orotracheal tube and cuffed endotracheal tube through the surgical field, 14 cases for double-lumen tube and 8 cases for endotracheal tube. During tracheal resection and tracheobroncheal reconstructio n, 25 patients were applied one-lung ventilation, 2 for two-lung ventilation and 3 for two lungs ventilation respectively. Conclusion Three modes of ventilation in the patients were able to establish and maintain ventilation sufficiently. Only-lung ventilation (OLV) was common usefully, but twolung ventilation and two lungs ventilation respectively were more physiological.