胸腔镜下保留自主呼吸与全身麻醉单肺通气肺大泡切除术的疗效比较
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摘要
目的:探讨对比胸腔镜下保留自主呼吸与全身麻醉单肺通气肺大泡切除术术中及术后对循环和呼吸的影响。方法:选取2016年1月至2017年12月符合条件的60例肺大泡患者,均分为两组。对照组接受全身麻醉单肺通气肺大泡切除术,观察组接受保留自主呼吸肺大泡切除术。记录并比较两组手术时间、术后复苏时间、住院时间,不同时间段的动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO2)、动脉血氧分压(partialarterialoxygenpressure,PaO2),每搏量(strokevolume,SV)、心输出量(cardiacoutput,CO)、有创平均动脉压(Invasivemeanarterialpressure,MAP)、心率(heart rate,HR)以及并发症发生情况。结果:观察组手术时间长于对照组,术后复苏时间及住院时间均短于观察组,差异均有统计学意义(P<0.05)。手术开始前两组各项心肺指标差异均无统计学意义(P>0.05)。手术开始15,30 min后及手术结束30 min后SV,CO,PaCO2,PaO2,MAP,H R指标观察组优于对照组(P<0.05)。结论:相比于全身麻醉单肺通气,保留自主呼吸方案能有效避免气管插管造成的呼吸道机械性损伤及异物造成的呼吸道感染,其对每搏量、心输出量、心率、动脉压等心肺功能影响较少,有利于动脉血PaCO2和PaO2保持在正常水平。
Objective: To investigate and compared the effect of thoracoscopic lung bullous resection of spontaneous breathing and general anesthesia with single lung ventilation and incidence of complications during surgery and after surgery. Methods: Sixty patients with pulmonary bullae from January 2016 to June 2017 were selected to be divided into two groups. The control group received with general anesthesia pneumoconiectomy for lung bullae resection, and the trial group accepted to retain spontaneous breathing for lung bullae resection. Partial pressure of carbon dioxide(PaCO2), partial arterial oxygen pressure(PaO2), stroke volume(SV), cardiac output(CO),invasive mean arterial pressure(MAP), heart rate(HR), operation time, hospitalization time, complications were recorded and compared in the two groups. Results: The operation time of the trial group was longer than that of the control group, while the postoperative resuscitation time and hospital stay were shorter than those in the control group, the differences were all statistically significant(P<0.05). There were no differences in cardiopulmonary parameters between the two groups before the surgery. The scores of SV, CO, PaCO2,PaO2, MAP and HR in the trial group were better than those in the control group at 15 min, 30 min after the surgery began and 30 min after the end of surgery. Conclusion: Compared to the general anesthesia single lung ventilation, retaining spontaneous breathing can effectively avoid respiratory injury caused by tracheal intubation and respiratory tract infection caused by foreign body. It has less impact on stroke volume, cardiac output, heart rate, arterial pressure and other cardiopulmonary functions. It is conducive to maintain partial pressure of arterial blood carbon dioxide and partial pressure of arterial oxygen on normal level.
Objective: To investigate and compared the effect of thoracoscopic lung bullous resection of spontaneous breathing and general anesthesia with single lung ventilation and incidence of complications during surgery and after surgery. Methods: Sixty patients with pulmonary bullae from January 2016 to June 2017 were selected to be divided into two groups. The control group received with general anesthesia pneumoconiectomy for lung bullae resection, and the trial group accepted to retain spontaneous breathing for lung bullae resection. Partial pressure of carbon dioxide(PaCO2), partial arterial oxygen pressure(PaO2), stroke volume(SV), cardiac output(CO),invasive mean arterial pressure(MAP), heart rate(HR), operation time, hospitalization time, complications were recorded and compared in the two groups. Results: The operation time of the trial group was longer than that of the control group, while the postoperative resuscitation time and hospital stay were shorter than those in the control group, the differences were all statistically significant(P<0.05). There were no differences in cardiopulmonary parameters between the two groups before the surgery. The scores of SV, CO, PaCO2,PaO2, MAP and HR in the trial group were better than those in the control group at 15 min, 30 min after the surgery began and 30 min after the end of surgery. Conclusion: Compared to the general anesthesia single lung ventilation, retaining spontaneous breathing can effectively avoid respiratory injury caused by tracheal intubation and respiratory tract infection caused by foreign body. It has less impact on stroke volume, cardiac output, heart rate, arterial pressure and other cardiopulmonary functions. It is conducive to maintain partial pressure of arterial blood carbon dioxide and partial pressure of arterial oxygen on normal level.
引文
1.余永康.单孔胸腔镜辅助小切口肺大泡切除术的临床疗效观察[J].中国医药指南, 2016, 14(9):68-69.YUYongkang.Clinicalobservationofsingle-holethoracoscopic assisted small incision pulmonary bullae resection[J]. Guide of China Medicine, 2016, 14(9):68-69.
2 .方志潮,刘秋凡,陈涛,等.改良腔镜切开缝合器应用于老年患者肺大泡切除术的临床观察[J].吉林医学, 2013, 34(21):4227-4228.FANG Zhichao, LIU Qiufan, CHEN Tao, et al. Clinical observation of modified endoscopic incision suture for pulmonary bullae resection in elderly patients[J]. Jilin Medical Journal, 2013, 34(21):4227-4228.
3 .吕忠元,吴宏艳,魏玉峰,等.胸腔镜辅助小切口肺大泡切除术55例临床分析[J].中国医学创新, 2012, 9(5):21-22.LüZhongyuan, WU Hongyan, WEI Yufeng, et al. Clinical analysis of 55 cases of thoracoscopic assisted small incision pulmonary bullae resection[J]. Chinese Medical Innovations, 2012, 9(5):21-22.
4 .熊理锋,谭瑞丹,徐冲敏,等.盐酸戊乙奎醚对胸腔镜肺大泡切除术患者呼吸力学的影响[J].临床麻醉学杂志, 2013, 29(7):684-685.XIONGLifeng,TANRuidan,XUChongmin,etal.Effectof penehyclidinehydrochlorideonrespiratorymechanicsinpatients undergoing thoracoscopic pulmonary bullae resection[J]. Journal of Clinical Anesthesiology, 2013, 29(7):684-685.
5 .张宏伟,于晓锋,董耀众,等.同期不变换体位胸腔镜双侧肺大泡切除术25例[J].中国胸心血管外科临床杂志, 2012, 19(2):220.ZHANG Hongwei, YU Xiaofeng, DONG Yaozhong, et al. 25 cases ofbilateralpulmonarybullousresectionwithoutthoracoscopic reconstruction[J].ChineseJournalofClinicalThoracicand Cardiovascular Surgery, 2012, 19(2):220.
6 .Liu TJ, Shih MS, Lee WL, et al. Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery[J]. Ann Thorac Surg, 2013, 96(1):127-132.
7 .陈章,廖小清,郑义文,等.单孔法在胸腔镜肺大泡切除术的临床应用研究[J].实用医院临床杂志, 2017, 14(3):79-80.CHENZhang,LIAOXiaoqing,ZHENGYiwen,etal.Clinical applicationofsingle-holemethodinthoracoscopicpulmonary bullous resection[J]. Practical Journal of Clinical Medicine, 2017,14(3):79-80.
8 .吴伟刚,黄耀联.胸腔镜辅助小切口肺大泡切除术的临床疗效观察[J].实用心脑肺血管病杂志, 2014, 22(3):91-92.WU Weigang, HUANG Yaolian. Clinical observation of thoracoscopic assisted small incision pulmonary bullae resection[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2014, 22(3):91-92.
9 .于文江,刘丽,贾伟,等.同期不变换体位行胸腔镜双侧肺大泡切除术效果探讨[J].国际医药卫生导报, 2013, 19(24):3728-3730.YU Wenjiang, LIU Li, JIA Wei, et al. Study on effects of unchanged body position in same term in bilateral bullae of lung excision with thoracoscope[J]. International Medicine&Health Guidance News,2013, 19(24):3728-3730.
10 .胡广男.胸腔镜下肺大泡切除的手术适应证选择及术后并发症分析[J].中国实用医药, 2015, 10(31):69-70.HU Guangnan. Selection of surgical indications and postoperative complications of thoracoscopic pulmonary bullae resection[J]. China Practical Medicine, 2015, 10(31):69-70.
11 .景向永.胸腔镜肺大泡切除术治疗肺大泡的临床效果观察[J].临床研究, 2017, 25(4):60-61.JING Xiangyong. Clinical effect of thoracoscopic pulmonary bulla resectioninthetreatmentofpulmonarybullae[J].Medicineand Health Care, 2017, 25(4):60-61.
12 .路泽华.胸腔镜辅助下行肺大泡切除术的临床疗效观察[J].中国医药指南, 2016,14(16):10-12.LUZehua.Toobservetheclinicalcurativeeffectofthoracoscopy pulmonarybullaeresection[J].GuideofChinaMedicine,2016,14(16):10-12.
2 .方志潮,刘秋凡,陈涛,等.改良腔镜切开缝合器应用于老年患者肺大泡切除术的临床观察[J].吉林医学, 2013, 34(21):4227-4228.FANG Zhichao, LIU Qiufan, CHEN Tao, et al. Clinical observation of modified endoscopic incision suture for pulmonary bullae resection in elderly patients[J]. Jilin Medical Journal, 2013, 34(21):4227-4228.
3 .吕忠元,吴宏艳,魏玉峰,等.胸腔镜辅助小切口肺大泡切除术55例临床分析[J].中国医学创新, 2012, 9(5):21-22.LüZhongyuan, WU Hongyan, WEI Yufeng, et al. Clinical analysis of 55 cases of thoracoscopic assisted small incision pulmonary bullae resection[J]. Chinese Medical Innovations, 2012, 9(5):21-22.
4 .熊理锋,谭瑞丹,徐冲敏,等.盐酸戊乙奎醚对胸腔镜肺大泡切除术患者呼吸力学的影响[J].临床麻醉学杂志, 2013, 29(7):684-685.XIONGLifeng,TANRuidan,XUChongmin,etal.Effectof penehyclidinehydrochlorideonrespiratorymechanicsinpatients undergoing thoracoscopic pulmonary bullae resection[J]. Journal of Clinical Anesthesiology, 2013, 29(7):684-685.
5 .张宏伟,于晓锋,董耀众,等.同期不变换体位胸腔镜双侧肺大泡切除术25例[J].中国胸心血管外科临床杂志, 2012, 19(2):220.ZHANG Hongwei, YU Xiaofeng, DONG Yaozhong, et al. 25 cases ofbilateralpulmonarybullousresectionwithoutthoracoscopic reconstruction[J].ChineseJournalofClinicalThoracicand Cardiovascular Surgery, 2012, 19(2):220.
6 .Liu TJ, Shih MS, Lee WL, et al. Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery[J]. Ann Thorac Surg, 2013, 96(1):127-132.
7 .陈章,廖小清,郑义文,等.单孔法在胸腔镜肺大泡切除术的临床应用研究[J].实用医院临床杂志, 2017, 14(3):79-80.CHENZhang,LIAOXiaoqing,ZHENGYiwen,etal.Clinical applicationofsingle-holemethodinthoracoscopicpulmonary bullous resection[J]. Practical Journal of Clinical Medicine, 2017,14(3):79-80.
8 .吴伟刚,黄耀联.胸腔镜辅助小切口肺大泡切除术的临床疗效观察[J].实用心脑肺血管病杂志, 2014, 22(3):91-92.WU Weigang, HUANG Yaolian. Clinical observation of thoracoscopic assisted small incision pulmonary bullae resection[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2014, 22(3):91-92.
9 .于文江,刘丽,贾伟,等.同期不变换体位行胸腔镜双侧肺大泡切除术效果探讨[J].国际医药卫生导报, 2013, 19(24):3728-3730.YU Wenjiang, LIU Li, JIA Wei, et al. Study on effects of unchanged body position in same term in bilateral bullae of lung excision with thoracoscope[J]. International Medicine&Health Guidance News,2013, 19(24):3728-3730.
10 .胡广男.胸腔镜下肺大泡切除的手术适应证选择及术后并发症分析[J].中国实用医药, 2015, 10(31):69-70.HU Guangnan. Selection of surgical indications and postoperative complications of thoracoscopic pulmonary bullae resection[J]. China Practical Medicine, 2015, 10(31):69-70.
11 .景向永.胸腔镜肺大泡切除术治疗肺大泡的临床效果观察[J].临床研究, 2017, 25(4):60-61.JING Xiangyong. Clinical effect of thoracoscopic pulmonary bulla resectioninthetreatmentofpulmonarybullae[J].Medicineand Health Care, 2017, 25(4):60-61.
12 .路泽华.胸腔镜辅助下行肺大泡切除术的临床疗效观察[J].中国医药指南, 2016,14(16):10-12.LUZehua.Toobservetheclinicalcurativeeffectofthoracoscopy pulmonarybullaeresection[J].GuideofChinaMedicine,2016,14(16):10-12.