小潮气量双肺通气在胸腔镜肺叶切除术患者气道管理中的效果观察

Effect observation of small tidal volume and double lung ventilation on airway management in patients undergoing thoracoscopic lobectomy

目的探究胸腔镜下肺叶切除患者行小潮气量双肺通气的临床应用价值。方法选取2016年9月～2017年9月我院确诊的40例行肺叶切除患者作为研究对象,根据随机盲选法将其分为观察组和对照组,每组各20例。观察组患者行单腔气管插管,术中行小潮气量双肺通气,对照组患者行双腔气管插管,术中行单肺通气。比较两组患者的麻醉插管完成时间、手术时间、苏醒时间及侧卧位后10 min(T_1)、手术开始后1 h(T_2)及手术结束后10 min(T_3)的脉搏氧饱和度(SpO_2)和动脉二氧化碳分压(PaCO_2)。结果观察组患者的麻醉诱导插管完成时间短于对照组,差异有统计学意义(P<0.05);两组患者的手术时间和苏醒时间比较,差异无统计学意义(P>0.05)。两组患者各时间点的SpO_2及PaCO_2比较,差异无统计学意义(P>0.05)。结论胸腔镜下肺叶切除患者应用小潮气量双肺通气的气道管理模式,操作简单,技术易掌握,且能避免单肺通气引起和加重的呼吸机相关性肺损伤,值得提倡使用。

Objective To explore the clinical application value of small tidal volume and double lung ventilation in patients undergoing thoracoscopic lobectomy.Methods A total of 40 patients who underwent lobectomy from September 2016 to September 2017 in our hospital were selected as the research subjects,and they were divided into the observation group and the control group according to the random blind selection method,with 20 cases in each group.The patients in the observation group were given single lumen endotracheal intubation,and double lung ventilation was performed during the operation.The patients in the control group were given double lumen endotracheal intubation,and single lung ventilation was performed during the operation.The completion time of anesthesia intubation,operation time,recovery time,and the pulse oxygen saturation(SpO2)and arterial partial pressure of carbon dioxide(PaCO2)at 10 min after the lateral position(T1),1 h after the start of the operation(T2)and 10 min after the end of the operation(T3)were compared between the two groups.Results The completion time of anesthesia intubation in the observation group was shorter than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in operation time and recovery time between the two groups(P>0.05).There were no significant differences in SpO2 and PaCO2 at each time point between the two groups(P>0.05).Conclusion The operation of airway management mode with small tidal volume and double lung ventilation in patients with thoracoscopic lobectomy is simple and easy to grasp.It can avoid ventilator associated lung injury caused by single lung ventilation,which is worthy of promotion and application.