改良预先单肺通气加快胸腔镜手术肺萎陷的效果及安全性评价

Efficacy and safety evaluation of modified preemptive one-lung ventilation for accelerating pulmonary atrophy during thoracoscopic surgery

目的评价改良预先单肺通气(OLV)在胸腔镜手术中加快术侧肺萎陷的效果及安全性。方法将2019年5月至2021年10月甘肃省肿瘤医院择期行肺楔形切除、肺叶切除术102例病人,按随机数字表法分配至常规OLV(C组)、预先OLV(P组)、改良预先OLV组(M组),每组34例。分别采用相应肺萎陷方法监测并记录病人胸腔开放后获得满意肺萎陷所需时间,胸腔开放后1、5、10、20、30 min肺萎陷评分,诱导前(T_(0))、插管后/膨肺前(T_(1))、侧卧前/膨肺末(T_(2))、侧卧后/膨肺后1 min(T_(3))、胸腔开放即刻(T_(4))、获得满意肺萎陷时刻(T_(5))的平均动脉压(MAP)、心率,T_(0)、T_(3)、T_(4)、T_(5)的脉搏血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2)),以及病人术中低氧血症发生、血管活性药物使用、术后肺部并发症及住院天数等情况。结果排除1例困难插管及7例胸腔粘连病人,最终94例病人研究数据被纳入分析。与C组[(14.8±2.8)min]及P组[(9.3±1.6)min]相比,M组[(6.8±1.3)min]病人胸腔开放后获得满意肺塌陷时间更短(均P<0.01);胸腔开放后1、5、10 min肺萎陷评分更高(均P<0.01)。M组病人各时间SpO_(2)、PaO_(2)、PaCO_(2)与P组相比差异无统计学意义(均P>0.05)。M组病人T_(2) MAP、心率较T_(1)、T_(3)短暂降低(均P<0.05)。三组病人无术中低氧血症发生;术中血管活性药物使用率、术后肺部并发症发生率、重症监护病房(ICU)转入率及术后住院天数组间比较均差异无统计学意义(均P>0.05)。结论改良预先OLV能更明显地加快胸腔镜手术双腔插管病人术侧肺萎陷,且对病人安全没有明显影响。

Objective To evaluate the efficacy and safety of modified pre one-lung ventilation(OLV)in thoracoscopic surgery for accelerating lung collapse on the operated side.Methods A total of 102 patients who underwent elective lung wedge resection and lobectomy at Gansu Provincial Cancer Hospital from May 2019 to October 2021 were allocated to the conventional OLV group(group C),pre-OLV group(group P),or modified pre-OLV group(group M)according to the randomized numerical table method,with 34 patients in each group.Corresponding lung collapse methods were used in each group of patients.The time required to obtain satisfactory lung collapse after chest opening;lung collapse scores at 1,5,10,20,and 30 min after chest opening;mean arterial pressure(MAP)and heart rate at the time before anesthetic induction(T_(0));postintubation or pre-lung dilation(T_(1));pre-lateral position or end-of-lung dilation(T_(2));one minute after lung dilation or post‑lateral position(T_(3));post-pleural opening(T_(4));and when satisfactory lung collapse occurred(T_(5))were monitored and record.The pulse oxygen(SpO_(2)),partial pressure of arterial oxygen(PaO_(2)),and partial pressure of arterial carbon dioxide(PaCO_(2))at T_(0),T_(3),T_(4),and T_(5) as well as the patients'occurrence of intraoperative hypoxemia,use of vasoactive drugs,postoperative pulmonary complications,and hospitalization days were recorded.Results The data of 94 patients,excluding 1 patient with difficult intubation and 7 patients with pleural adhesions,were included in the analysis.Compared with those in group C[(14.8±2.8)min]and group P[(9.3±1.6)min],patients in group M[(6.8±1.3)min]had a shorter time to achieve satisfactory lung collapse after thoracic cavity opening[(6.8±1.3)min](all P<0.01)and higher lung collapse scores at 1,5,and 10 min after thoracic cavity opening(all P<0.01).There was no significant difference in SpO_(2),PaO_(2) or PaCO_(2) at any time between the M group and the P group(all P>0.05).The T_(2) MAP and heart rate were transiently lower in the M group than in the T_(1) and T_(3)(all P<0.05).No intraoperative hypoxemia occurred in any of the three groups;the differences in intraoperative vasoactive drug use rate,postoperative pulmonary complication rate,intensive care unit(ICU)transfer rate,and postoperative hospitalization days were not statistically significant between the groups(all P>0.05).Conclusion Modified pre-OLV can significantly accelerate the lung collapse on the operative side in patients undergoing thoraco-scopic surgery with double-lumen tubes without a significantly impacting on patient safety.