两种不同入路胸腔镜胸腺切除术对MG患者血气及相关指标的影响  

Effects of two different approaches of thoracoscopic thymectomy on blood gas and related indexes in patients with MG

作　　者：陈何伟 杨艳超[1] 潘晓伟 潘祖林 陈艺匀 CHEN Hewei;YANG Yanchao;PAN Xiaowei(Department of Anesthesia,The First Hospital of Shijiazhuang City, Hebei, Shijiazhuang 050011, China)

机构地区：[1]河北省石家庄市第一医院麻醉科,050011 [2]河北省石家庄市第一医院妇科,050011 [3]河北省石家庄市第一医院胸腺外科,050011 [4]南方医科大学卫生管理学院

出　　处：《河北医药》2020年第2期265-267,271,共4页Hebei Medical Journal

基　　金：河北省石家庄市科技局课题(编号:181201063)

摘　　要：目的研究两种不同入路胸腔镜胸腺切除术对重症肌无力(MG)患者血气、氧合指数、脉搏氧饱和度、肺内分流率、气道压、肺动态顺应性的影响。方法回顾性分析2017至2018年行胸腔镜胸腺切除MG患者60例,其中右胸入路胸腔镜胸腺切除术30例(Y组),剑突下入路胸腔镜胸腺切除术30例(J组)。分别于全麻插管后,通气5 min(T1),通气30 min(T2),通气60 min(T3),关胸后即刻(T4),抽取动脉血进行血气分析,计算氧合指数(OI)、肺内分流率(Qs/Qt),同时监测记录脉搏氧饱和度(SpO2)、气道峰压(Pmax)并根据公式计算肺动态顺应性(Cdyn)。结果T1、T4时点Y组与J组比较,pH值、PaO2、OI、SpO2、Qs/Qt差异无统计学意义(P>0.05);T2、T3时点,Y组与J组比较,pH值、PaO2、OI、SpO2明显降低,Qs/Qt明显升高,差异有统计学意义(P<0.05)。T1~T4时点,Y组与J组比较,PaCO2差异无统计学意义(P>0.05),与T1比较,T2、T3时点2组PaCO2都有升高,但均在正常范围。T2、T3时点,Y组与J组比较,Pmax显著增高,Cdyn明显下降,差异有统计学意义(P<0.05)。T1、T4时点,2组Pmax、Cdyn比较差异无统计学意义(P>0.05)。结论与右胸入路胸腔镜胸腺切除术相比,剑突下入路胸腔镜胸腺切除术对患者血气、OI、SpO2、Qs/Qt、Pmax、Cdyn的影响较小,氧合更好。Objective To investigate the effects of two different approaches of thoracoscopic thymectomy on blood gas,oxygenation index,pulse oxygen saturation,intrapulmonary shunt rate,airway pressure and pulmonary dynamic compliance in patients with myasthenia gravis(MG).Methods The clinical data about 60 patients with MG who were treated by thoracoscopic thymectomy in our hospital from January 2017 to December 2018 were retrospectively analyzed,of whom,30 patients were treated by right approach thoracoscopic thymectomy(group Y),the other 30 patients were treated by xiphoid process approach thoracoscopic thymectomy(group J).After intubation under general anaesthesia,the blood gas analysis was performed at ventilation 5min(T1),ventilation 30min(T2),ventilation 60min(T3),chest immediately after closing(T4)to calculate the oxygenation index(OI)and pulmonary shunt rate(Qs/Qt),at the same time,the pulse oxygen saturation(SpO2),airway peak pressure(Pmax)were recorded,moreover,the dynamic compliance of the lungs(Cdyn)was calculated according to the formula.Results There were no significant differences in pH value,PaO2,OI,SpO2,Qs/Qt at T1 and T4 between group Y and group J(P>0.05),and the PH value,PaO2,OI,SpO2 at T2 and T3 in group Y were significantly lower than those in group J,but Qs/Qt was significantly higher than that in group J(P<0.05).There were no significant differences in PaCO2 levels at T1~T4 between group Y and group J(P>0.05).As compared with those at T1,the PaCO2 levels were increased in both groups at T2 and T3,but,which were in normal range.In addition the Pmax at T2 and T3 in group Y was increased significantly,however,the Cdyn was decreased significantly,as compared with that in group J(P<0.05).However there were no significant differences in Pmax and Cdyn at T1 and T4 between the two groups(P>0.05).Conclusion As compared with right approach thoracoscopic thymectomy,the xiphoid process approach thoracoscopic thymectomy has less effects on blood gas,OI,SpO2,Qs/Qt,Pmax,Cdyn of patients with MG,with better oxygenat

关 键 词：不同入路胸腔镜 血气 氧合指数 肺内分流率 气道压 肺动态顺应性 

分 类 号：R746.1[医药卫生—神经病学与精神病学]