剑突下入路胸腔镜切除术与传统开胸胸腺切除术对重症肌无力患者血气及相关指标的影响

The effects of subxiphoid thoracoscopy and traditional thymectomy on blood gas and related indexes in patients with myasthenia gravis

目的比较剑突下入路胸腔镜与传统开胸胸腺切除术式对重症肌无力(MG)患者血气、肺内分流率、气道压、肺动态顺应性的影响。方法回顾性分析2015年1月至2018年12月行全胸腺切除MG患者60例,其中传统开胸胸腺切除术30例(K组),剑突下入路胸腔镜胸腺切除术30例(J组)。分别于全麻插管后、通气5 min(T1)、通气30 min(T2)、通气60 min(T3),关胸后即刻(T4)抽取动脉血进行血气分析,计算肺内分流率(Qs/Qt),同时监测记录气道峰压(Pmax)并根据公式计算肺动态顺应性(Cdyn)。结果T1、T4时点J组与K组比较,pH值、PaO2、PCO2、BE值差异无统计学意义(P>0.05);T2、T3时点,J组与K组比较,pH值、PaO2、BE值明显降低,PCO2明显升高,差异有统计学意义(P<0.05)。T1、T4时点,J组与K组比较,Qs/Qt差异无统计学意义(P>0.05),T2、T3时点,J组与K组比较,Qs/Qt显著增高,差异有统计学意义(P<0.05)。T1、T4时点,J组与K组比较,Pmax、Cdyn差异无统计学意义(P>0.05),T2、T3时点,J组与K组比较,Pmax显著增高,Cdyn明显下降,差异有统计学意义(P<0.05)。结论传统开胸胸腺切除术和剑突下入路胸腔镜胸腺切除术对患者血气、肺内分流率、气道峰压、肺动态顺应性均会产生一定的影响,与传统开胸胸腺切除术相比,剑突下入路胸腔镜胸腺切除术对患者血气、肺内分流率、气道峰压、肺动态顺应性的影响较大。

Objective To investigate the effects of subxiphoid thoracoscopy and traditional thymectomy on blood gas,intrapulmonary shunt rate,airway pressure and pulmonary dynamic compliance in patients with myasthenia gravis(MG).Methods The clinical data about 60 patients with MG who underwent total thymectomy in our hospital from January 2015 to December 2018 were retrospectively analyzed,These patients were divided into group K and group J,with 30 cases in each group.The patients in group K were treated by traditional thymectomy,however,the patients in group J were treated by subxiphoid approach thymectomy.After general anesthesia intubation,the blood gas indexes at 5min after ventilation(T1),30 min(T2),60 min(T3),and immediately after chest closure(T4)were analyzed to calculate the intrapulmonary shunt rate(Qs/Qt).At the same time the peak airway pressure(Pmax)was monitored and recorded to calculate the pulmonary dynamic compliance(Cdyn)according to the formula.Results There were no significant differences in pH value,PaO2,PCO2 and the BE value at T1 and T4 between the group J and group K(P>0.05).The pH value,PaO2,PCO2 and the BE value at T2 and T3 in the group J were significantly lower than those in group K,however the PCO2 in group J was significantly higher than that in group K(P<0.05).The was no significant difference in Qs/Qt at T1 and T4 between the two groups(P<0.05),which at T2 and T3 in group J was significantly higher than that in group K(P<0.05).There were no significant differences in Pmax and Cdyn at T1 and T4 between the two groups(P>0.05),but the Pmax at T2 and T3 in group J was significantly higher than that in goup K,and Cdyn in group J was significantly lower than that in group K(P<0.05).Conclusion Both traditional open chest thymusectomy and thoracoscopic thymusectomy via subxiphoid approach have certain effects on the blood gas,intrapulmonary shunt rate,airway peak pressure,lung dynamic compliance of patients.As compared with traditional open chest thymusectomy,the thoracoscopic thymusectomy via subxiphoid approach have more obvious effects on the blood gas,intrapulmonary shunt rate,airway peak pressure,lung dynamic compliance of patients.