小潮气量快频率间歇正压通气在全胸腔镜下心脏手术中的应用  

Application of Low Tidal Volume and High Frequency Intermittent Positive Pressure Ventilation in Thoracoscopic Cardiac Surgery

作　　者：邓友明[1] 张维峰[1] 赵秀芳 程云阁[3] 王连才[4] 

机构地区：[1]南京市第二医院麻醉科,南京210003 [2]上海远大心胸医院麻醉科,上海200235 [3]南京市第二医院心外科,南京210003 [4]南京市第二医院体外循环科,南京210003

出　　处：《中国微创外科杂志》2014年第6期481-483,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨单腔气管插管，小潮气量快频率间歇正压通气（intermittent positive pressure ventilation，IPPV）在电视胸腔镜心脏手术麻醉中的可行性和安全性。方法2008年1月-2009年8月对85例（4—58岁，体重15—82kg）电视胸腔镜下心脏手术采用小潮气量快频率IPPV的呼吸管理模式，观察气管插管后行常规IPPV后10min（T1）、小潮气量较快频率IPPV呼吸模式后10min（T2）、体外循环停机后行小潮气量较快频率IPPV模式后10min（T3）、胸腔镜操作结束后常规IPPV后10min（IT4）动脉血气和呼气来CO2分压（PETCO2）。结果所有患者均能耐受单腔气管插管，小潮气量快频率IPPV下电视胸腔镜心脏手术。T1～T4时点PaCO2分别为（38．4±2．0），（39．0±2．2），（38．7±2．1），（38．6±2．0）mmHg；PaO2分别为（387．7±57．5），（137．5±35．0），（134．6±31．2），（284．2±45．2）mmHg，提示无缺氧和CO2蓄积。无麻醉相关并发症发生，术野暴露良好。与T1比较，T2、T3、T4时点PaO2降低有统计学差异（P〈0．05），但在动脉血氧正常范围内。结论电视胸腔镜下心脏手术中使用单腔气管插管行小潮气量快频率IPPV通气模式，能提供良好的手术野和合适的通气，可作为电视胸腔镜下心脏手术呼吸管理的一种理想的选择。Objective To evaluate the feasibility and safety of low tidal volume and high frequency intermittent positive pressure ventilation （IPPV）with single-lumen endotracheal tube （SLET）during the anesthesia for thoracoscopic cardiac surgery. Methods The clinical data of 85 patients undergoing thoracoscopic cardiac surgery from January 2008 to August 2009, aged 4 -58 years old, weighted 15 -82 kg, were reviewed. Low tidal volume and high frequency IPPV with SLET was performed in all the patients during thoracoscopic cardiac surgery. The arterial blood gas results and PETCO2 measures were statistically analyzed at the time points of 10 min after endotracheal intubation （T1）, 10 min after small-tidal volume and high- frequency IPPV （T2）, 10 rain small-tidal volume and high-frequency IPPV after the weaning of CPB （T3）, and 10 min IPPV after the end of operation （T4）, respectively. Results The anesthesia strategy of slngle-lumen endotracheal intubation combining low tidal volume fast frequency IPPV was well tolerated by all the patients. The values of PaCO2 were （38.4 -s 2.0） , （39.0 ± 2.2） , （38.7 ± 2.1 ） , （ 38.6 ± 2.0 ） mm Hg, and the values of PaO2 were （387.7 ±57.5）, （137.5 ±35.0）, （134.6 ±31.2）, （284.2 ±45.2） mm Hg atT1, T2, T3, and T4, respectively, which indicated that there were no hypoxia and carbon dioxide accumulation. No anesthesia related complications occurred. The surgical vision exposure was good. As compared with T1, the PaO2 values were much lower at T2, T3, and T4, with statistical significance （P 〈 0.05） , but in the normal range of arterial oxygen. Conclusions Low tidal volume and high frequency IPPV with SLET can be safely used in the anesthesia for video assisted thoracoscopic cardiac surgery, providing a good vision. It is an ideal choice of respiratory management for thoracoscopic cardiac surgery.

关 键 词：胸腔镜 心脏手术 快频率 间歇正压通气 小潮气量 

分 类 号：R614[医药卫生—麻醉学]