单肺通气对泌尿外科腹膜后腔镜手术患者皮下气肿发生的影响  

Effect of one-lung ventilation on occurrence of subcutaneous emphysema in patients undergoing retroperitoneal laparoscopic urologic surgery P

作　　者：任全[1] 李菁[1] 袁静[1] 彭贞丹[1] 陈恕求[2] 陈明[2] 景亮[1] 

机构地区：[1]东南大学附属中大医院麻醉科,南京市210009 [2]东南大学附属中大医院泌尿外科,南京市210009

出　　处：《中华麻醉学杂志》2012年第8期920-922,共3页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金（81070592）

摘　　要：目的评价单肺通气对泌尿外科腹膜后腔镜手术患者皮下气肿发生的影响。方法择期泌尿外科腹膜后腔镜手术患者27例，年龄29～64岁，体重指数19～25kg／m2，ASA分级I或Ⅱ级。采用随机数字表法，将患者随机分为2组：双肺通气组（I组，n=15）和单肺通气组（Ⅱ组，n=12）。I组插入气管导管行双肺通气，Ⅱ组插入左侧双腔支气管导管行双肺通气，于气腹前10～15min行非手术侧单肺通气至气腹结束后恢复双肺通气。于气腹前、气腹30rain、60min及气腹结束后30min时记录PETCO2、分钟通气量，计算C02吸收量。气腹结束时记录皮下气肿的发生情况并评估皮下气肿程度。结果与I组比较，Ⅱ组C02吸收量减少，皮下气肿程度和皮下气肿发生率降低（P〈0．05）。结论泌尿外科行腹膜后腔镜手术气腹期间，非手术侧单肺通气可减少CO2吸收量，降低皮下气肿的程度，减少皮下气肿的发生。Objective To investigate the effect of one-lung ventilation （OLV） on the occurrence of subcu- tanous emphysema during retroperitoneal laparoscopic urologic surgery （RPLUS）. Methods Twenty-seven ASA Ⅰ or Ⅱ patients, aged 29-64 yr, with body mass index 19-25 kg/m2 , scheduled for elective RPLUS, were randomly divided into 2 groups： two-lung ventilation （TLV） group （group Ⅰ, n = 15） and OLV group （group Ⅱ , n = 12）. In group Ⅰ , the patients were tracheal intubated and TLV was performed. In group Ⅱ , the left-sided double lumen endobronchial tube was inserted and TLV was performed, OLV on the non-operated side was performed starting from 10-15 rain before pneumoperitoneum and TLV resumed at the end of pneumoperitoneum. The end-tidal CO2 partial pressure and minute ventilation volume were measured before pneumoperitoneum （Tl）, at 30 and 60 rain of pneumoperitoneum （T2.3 ）, and at 30 rain after the end of pneumoperitoneum （T4）. The CO2 absorption capacity was calculated. The degree of pneumoderma was assessed and the occuranee of pneumoderma was recorded at the end of pneumoperitoneum. Results Compared with group Ⅰ ,. the CO2 absorption capacity was significantly re- duced, and the degree and incidence of pneumoderma were significantly decreased in group Ⅱ （ P 〈 0.05）. Con- clusion OLV on the non-operated side can reduce the C02 absorption capacity, decrease the degree of subcutane- ous emphysema and reduce the occurrence of subcutanous emphysema during pneumoperitoneum in patients underg- oing RPLUS.

关 键 词：皮下气肿 肺通气 腹膜后间隙 腹腔镜 

分 类 号：R614[医药卫生—麻醉学]