应用“三角帆”技术在间断双肺通气下实施左胸小切口多支冠状动脉旁路移植术

Intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting on the application of triangular-sail technique

目的分析采用"三角帆"技术,在经左胸小切口多支冠状动脉旁路移植术(MICS CABG)中实现间断双肺通气的可行性。方法回顾性分析2019年1月至2020年11月于我中心接受MICS CABG手术的207患者的临床资料,分为单肺通气组(111例)和双肺通气组(96例)。双肺通气组应用"三角帆"技术悬吊心包外脂肪组织,隔绝肺组织与术野,术中进行间断双肺通气。对比分析两组患者术前资料以及围术期临床结果。结果单肺通气组与双肺通气组术前基本资料差异无统计学意义。单肺通气组搭桥数量少于双肺通气组(2.8±0.8 vs.3.1±0.8,P=0.015),手术时间也短于双肺通气组[(296.7±57.3)min vs.(334.1±87.0)min,P=0.000]。两组术后机械通气时间、ICU住院时间及术后住院总时间差异无统计学意义。两组气胸、肺不张的发生率差异无统计学意义。结论 "三角帆"技术简单易行,可在MICS CABG手术过程中实现间断双肺通气。

Objective To analyze the feasibility of using triangular-sail technique that allows intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting(MICS CABG).Methods The clinical data of207 patients with MICS CABG in our cardiac center from January 2019 to November 2020 were retrospectively analyzed.These patients were divided into two groups.A group OLV included 111 patients who underwent one-lung ventilation during surgery,while a group TLV included 96 patients who underwent intermittent two-lung ventilation.The triangularsail technique was used in the group TLV.This simple technique isolated the operative field from lung lobes with the traction of pericardial adipose tissue.The preoperative data and perioperative clinical data of the two groups were compared and analyzed.Results There was no statistical difference in basic preoperative data between the two groups.The operation time in the OLV group was shorter than that in the TLV group(296.7±57.3 min vs.334.1±87.0 min,P=0.000),and the duration of postoperative mechanical ventilation and ICU stay were not statistically different between the two groups.There was also no statistical difference in the incidence of pneumothorax or atelectasis between the two groups.Conclusion The triangular-sail technique is simple and easy to implement.The technique allows intermittent two-lung ventilation during MICS CABG procedure.