实现单侧肺萎陷的三种插管技术在胸腔镜食管癌根治术中的临床效果

Clinical effect of three intubation techniques used for unilateral lung collapse in thoracuscopic radical resection of esophageal cancer

目的比较实现单侧肺萎陷的支气管封堵器、双腔气管导管和单腔气管导管联合CO_(2)人工气胸三种插管技术在胸腔镜食管癌根治术中的临床效果。方法行胸腔镜食管癌根治术的90例中下段食管癌患者随机分为三组,每组30例,分别采用支气管封堵器(A组)、双腔气管导管(B组)和单腔气管导管联合CO_(2)人工气胸(C组)的插管技术实现单侧肺萎陷。比较三组临床资料,记录手术开始前双肺通气(T1)、单侧肺萎陷40 min(T2)、单侧肺萎陷80 min(T3)和双肺通气后30 min(T4)时的HR、MAP、气道峰压(Ppeak)、PaCO_(2)、SpO_(2)和动脉血pH值。结果A组插管时间长于B组和C组(P<0.05);A组和B组使用纤维支气管镜比例多于C组(P<0.05),B组术后发生咽痛和声音嘶哑的比例多于A组和C组(P<0.05)。T2和T3时,B组Ppeak高于A组(P<0.05),C组HR、PaCO_(2)和Ppeak高于A组和B组(P<0.05),C组MAP、动脉血pH值均低于A组和B组(P<0.05)。A组、B组T2和T3时Ppeak高于T1和T4时(P<0.05),C组T2和T3时HR、Ppeak和PaCO_(2)高于T1和T4时(P<0.05),C组T2和T3时MAP、动脉血pH值低于T1和T4时(P<0.05)。结论单腔气管导管联合CO_(2)人工气胸操作简单,成功率高,术后插管并发症少,但在术中易发生HR和血压波动以及高碳酸血症;而支气管封堵器和双腔气管导管需要更高的操作技术。术前需根据患者情况、手术要求、硬件设施和麻醉医生技术水平选择最适合的插管方式。

Objective To compare the clinical effect of three intubation techniques including bronchial occluder,double lumen tube and single lumen tube combined with CO_(2)artificial pneumothorax used for unilateral lung collapse in thoracoscopic radical resection of esophageal cancer.Methods Ninety patients with middle and lower esophageal carcinoma undergoing thoracoscopic radical resection of esophageal cancer were divided into three groups with 30 cases each.Unilateral lung collapse was produced by bronchial occluder(group A),double lumen tube(group B),or single lumen tube combined with CO_(2)artificial pneumothorax(group C).The clinical data of the three groups were compared.HR,MAP,Peak airway pressure(Ppeak),PaCO_(2),SpO_(2)and arterial blood pH value were recorded at the time points of before operation(T1),unilateral lung collapse for 40 minutes(T2),unilateral lung collapse for 80 minutes(T3),and 30 minutes after bilateral ventilation(T4).Results The intubation time of group A was longer than that of groups of B and C(P<0.05).The proportion of bronchoscopy in groups of A and B was higher than that in group C(P<0.05).The incidence of postoperative sore throat and hoarseness in group B was higher than that in groups of A and C(P<0.05).At T2 and T3,Ppeak was higher in group B than that in group A(P<0.05),and HR,PaCO_(2)and Ppeak were higher and MAP and arterial pH value were lower in group C than those in groups of A and B(P<0.05).Ppeak was higher at T2 and T3 than that at T1 and T4 in groups of A and B(P<0.05),and HR,Ppeak and PaCO_(2)were higher,and MAP and arterial pH were lower at T2 and T3 than those at T1 and T4 in group C(P<0.05).Conclusion The single lumen tube combined with CO_(2)artificial pneumothorax technique has the advantages of simple operation,high success rate and fewer postoperative intubation complications,but is prone to produce HR and blood pressure fluctuations and hypercapnia during the operation.While the bronchial occluder and double iumen tube require higher operation technique,The most suitable intubation method should be selected before operation according to the condition of patients,surgical requirements,hardware facilities and technology of anesthesiologist.