不同单肺通气方案在胸腔镜食管癌根治术中的应用效果

Application of different one-lung ventilation schemes in thoracoscopic radical resection of esophageal carcinoma

目的:探讨不同单肺通气方案在胸腔镜食管癌根治术中的应用效果。方法:抽取南阳医学高等专科学校第一附属医院2017年4月至2020年4月择期行胸腔镜食管癌根治术的100例食管癌患者,按随机数字表法分为观察组和对照组,每组50例。对照组采用双腔气管插管行单肺通气,观察组采用单腔气管插管+人工气胸行单肺通气。比较两组手术一般资料,分析两组单肺通气前(T0)、单肺通气后1 h(T1)、单肺通气结束时(T2)血氧饱和度(SpO 2)、呼气末二氧化碳分压(PETCO 2)、平均动脉压(MAP),同时测定两组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、肺活量(VC)、1秒用力呼气容积(FEV1),并观察术后肺部并发症。结果:观察组手术时间、住院时间、插管时间短于对照组,术中出血量低于对照组,淋巴结清扫数量较对照组多,差异均有统计学意义(P<0.05);T1时观察组PETCO 2明显高于对照组(P<0.05),两组T1时SpO 2低于同组T0时,MAP较同组T0时增加,但T0、T2时组间SpO 2、PETCO 2、MAP比较差异未见统计学意义(P<0.05);观察组术后血清TNF-α、IL-6低于对照组,而VC、FEV1较对照组增加(P<0.05);观察组术后肺部相关并发症发生率4.00%低于对照组16.00%(P<0.05)。结论:单腔气管插管+人工气胸行单肺通气可明显提高胸腔镜食管癌根治术中淋巴结清扫数量,缩短康复进程,减少肺功能损伤及相关并发症。

Objective To analyze the application of different one-lung ventilation schemes in thoracoscopic radical resection of esophageal carcinoma.Methods A total of 100 cases of patients undergoing thoracoscopic radical resection of esophageal carcinoma in the First Affiliated College of Nanyang Medical College from April 2017 to April 2020 were selected for the study,and they were divided into observation group and control group randomly according to random number table method,with 50 cases in each group.The control group was given double-lumen endotracheal intubation for one-lung ventilation,the observation group was given single-lumen endotracheal intubation and artificial pneumothorax for one-lung ventilation.The general surgical data were compared,and the oxygen saturation(SpO2),end tidal carbon dioxide partial pressure(PETCO2),mean arterial pressure(MAP)before one-lung ventilation(T0)and at 1h after one lung ventilation(T1)and at the end of one-lung ventilation(T2)were analyzed in the two groups,and the levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),vital capacity(VC)and forced expiratory volume in 1 second(FEV1)were measured in the two groups,and postoperative pulmonary complications were observed.Results The operative time,hospital stay and intubation time of the observation group were shorter than those of the control group,and the intraoperative blood loss was lower than that of the control group,and the number of lymph node clearance was more than that of the control group(P<0.05).The PETCO2 at T1 in the observation group was significantly higher than that in the control group(P<0.05),and the SpO2 at T1 of the two groups was lower than that at T0 in the same group.MAP was higher than that in the same group at T0,but there were no significant differences in SpO2,PETCO2 and MAP between the two groups at T0 and T2(P<0.05).The levels of serum TNF-αand IL-6 after operation in the observation group were lower than those in the control group,and VC and FEV1 were increasedcompared with those in the control group(P<0.05).The incidence rate of postoperative pulmonary complications in the observation group was significantly lower than that in the control group(4.00%vs.16.00%),P<0.05.Conclusions Single-lumen endotracheal intubation plus artificial pneumothorax for one-lung ventilation can significantly improve the number of lymph node clearance in the thoracoscopic radical resection of esophagealcarcinoma,shorten the rehabilitation process and reduce lung function injury and related complications.