不同单肺通气方式在全腔镜食管癌根治术中的应用

Different Ways of Single-lung Ventilation in Thoracoscopic-laparoscopic Radical Esophagectomy

目的比较单腔气管导管配合人工气胸与双腔支气管导管在全腔镜食管癌根治术中的应用。方法选取择期行全腔镜食管癌根治术患者100例,随机分为Ⅰ组(单腔气管导管组)和Ⅱ组(双腔支气管导管组)。Ⅰ组通过单腔气管插管持续吹入二氧化碳实施人工气胸实现单肺通气;Ⅱ组通过双腔支气管插管实现单肺通气。比较2组患者的插管时间、术野暴露程度、术后咽喉痛的发生情况及单肺通气前(T1)、单肺通气后1h(T2)、单肺通气结束时(T3)的血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、气道压(Paw)、中心静脉压(CVP)、心率(HR)和平均动脉压(MAP)。结果Ⅰ组插管时间和术后咽喉痛发生率明显低于Ⅱ组(P<0.05);2组的术野暴露程度差别无统计学意义;在T2、T3时间点Ⅰ组患者的PETCO2和CVP明显高于Ⅱ组(P<0.05);在T1时间点2组患者的PETCO2和CVP比较,差别无统计学意义;在各个时间点2组患者的SpO2、Paw、HR和MAP比较,差别无统计学意义。结论单腔气管导管配合人工气胸与双腔支气管导管均能有效安全地应用于全腔镜食管癌根治术中,但单腔气管导管具有插管容易、耗时短、术后咽喉痛发生率少等优势,在全腔镜食管癌根治术中可推广应用。

Objective To compare the application of single-lumen endotracheal tube matched with artificial pneumothorax and double-lumen endobronchial tube in the radical treatment of full endoscopic esophagus cancer. Methods To collect 100 patients with full endoscopic esophagus cancer, who are randomly divided into group Ⅰ （single-lumen endotracheal tube group） and group Ⅱ （double-lumen endo- bronchial tube group）. In group I , the carbon dioxide is steadily transmitted to achieve the single-lung ventilation through a single-lumen endotracheal intubation and artificial pneumothorax. In group Ⅱ , the single-lung ventilation is conducted through double-lumen endobronchial intubation. To compare the two groups patients＇ intubation time, surgical satisfaction, postoperative sore throat, blood oxygen saturation （SpOz） in one hour that is separately before （T1） and after （T2） the single-lung ventilation and the end of single-lung ventilation （T3）, end-expiratory carbon dioxide partial pressure （PETCOe）, airway pressure （Paw）, central venous pressure （CVP）, heart rate （HR） and mean arterial pressure （MAP）. Results The intubation time and postoperative pharyngalgia in group I was significantly lower than that of group Ⅱ（P 〈0.05）. The visible range in operation has no significant difference. At the time point of T2 and T3, the PE.rCO2 and CVP in group I were significantly higher than that of group Ⅱ （P d0.05）. At the time point T1, the PETCO2 and CVP difference between two groups has no statistical significance. The difference of SpO2, Paw, HR and MAP between the two groups at each time point has no statistical significance. Conclusion The single-lumen endotracheal tube with artificial pneumothorax and double-lumen endobronchial tube, both of two single-lung ventilation modes are able to be effectively and safely used in the radical treatment of full endoscopic esophagus cancer, but the single-lumen endotracheal tube has many advantages, such as simple intubation, short needed time, less postoperative pharyngalgia rate and other advantages, therefore, it can be promoted in the radical treatment of full endoscopic esophagus cancer.