2种气管插管人工气胸食管癌根治术临床疗效比较

Clinical effect of single lumen tracheal intubation in the radical surgery of esophageal cancer with artificial pneumothorax

目的比较2种气管插管人工气胸食管癌根治术的临床效果。方法选取2013年10月-2015年10月实施胸腔镜下食管癌根治术患者100例,平均体质量（62±8.10）kg,美国麻醉医师协会分级Ⅱ～Ⅲ级,术前血气分析和肺功能检查提示可以耐受单肺通气,依照患者的不同气管插管方式分成对照组和试验组,每组50例,对照组患者双腔气管插管,术中实施单肺通气方法;试验组患者单腔气管插管,术中实施人工气胸方法。比较两组患者气管插管后30min（T1）、人工气胸后（单肺通气）30min（T2）、人工气胸后（单肺通气）90min（T3）、人工气胸结束（双肺通气）30min（T4）时的心率（HR）、中心静脉压（CVP）、气道压（Paw）、平均动脉压（MAP）、脉搏血氧饱合度（SpO2）、呼气末二氧化碳（CO_2）分压（PETCO_2）、pH、术后并发症发生率及气管插管所需要时间。结果 CO_2吹入造成人工气胸后,试验组患者T2阶段的HR、CVP、SpO_2、PAW、PETCO_2、PaCO_2、MAP均高于对照组组,同时pH值较对照组患者下降,差异均有统计学意义（P〈0.05）;两组患者T3阶段HR、CVP、PETCO_2、PaCO_2各项指标比较差异均有统计学意义（P〈0.05）;两组患者T4阶段PaCO_2比较差异有统计学意义（P〈0.05）;试验组术后并发症发生率明显低于对照组,差异有统计学意义（P〈0.05）;试验组插管所需要时间明显短于对照组（P〈0.05）。结论 2种方法均能在维持血流动力学平稳状态下完成胸腔镜下食管癌根治术,单腔气管插管人工气胸方法在降低术后呼吸系统并发症、缩短气管插管时间方面有优势;在维持机体呼吸性酸碱平衡方面,双腔气管导管单肺通气方法更为可行。

Objective To investigate the clinical effect of single lumen tracheal intubation in the treatment of esophageal cancer with artificial pneumothorax.Methods From October 2013 to 2015,100 cases of patients with esophageal carcinoma with（62±8.10）kg of body weight and ASA gradeⅡ-Ⅲ were selected,who would be implement the radical surgery of esophageal carcinoma.The blood gas analysis and pulmonary function tests suggest that all the patients can tolerate single lung.According to different patients′tracheal intubation,they were divided equally into control group and experimental group.Double lumen endotracheal intubation and one lung ventilation method were implemented in the control group,whilethe single lumen endotracheal intubation and intraoperative artificial pneumothorax were implemented in the experimental group.The indexed such as heart rate（HR）,central venous pressure（CVP）,airway pressure（PAW）,mean arterial pressure（MAP）,pulse oxygen saturation（SpO2）,end tidal CO_2（PetCO_2）,pH changes of patients in two groups were compared at different stages,such as after tracheal intubation 30 min（T1）,after artificial pneumothorax（one lung ventilation）30 min（T2）,artificial pneumothorax（one lung ventilation）90min（T3）,artificial pneumothorax over（double lung ventilation）30min（T4）;The incidence of postoperative respiratory complications and the time required for tracheal intubation in the two groups were analyzed,too.Results After artificial pneumothorax caused by carbon dioxide insufflation,at T2 stage CVP,PETCO_2,HR,SpO_2,PAW,MAP and PaCO_2 of patients in the experiment group was significantly higher than that inthe control group,while the blood pH of the patients in the experiment group decreased significantly（P〈0.05）;HR,CVP,PETCO_2,and PaCO_2 at T3 stage and PaCO_2 at T4stage in the two groups of patients were significantly different（P〈0.05）.Postoperative respiratory complications in the experimental group were significantly lower than those in the control group,and the difference was significant（P〈0.05）;the time of intubation was significantly lower in the experimental group than that of the control group（P〈0.05）.Conclusion Both of the methods can maintain the stable hemodynamics state to complete thoracoscopic esophageal cancer radical operation.The single lumen endotracheal intubation and artificial pneumothorax method has advantage in reducing postoperative respiratory system complications,shorten the duration of intubation,reduce hospitalization cost;double lumen endotracheal tube of single lung ventilation,is more feasible in maintaining the body′s respiratory acid-base balance.