强度肺复张联合双肺通气或单肺通气对全腔镜食管癌根治术后患者肺功能的影响  

Effect of intensive lung recruitment combined with double-or single-lung ventilation on pulmonary function in patients after total endoscopic radical resection of esophageal carcinoma

作　　者：梁正[1] 李朝玉[1] 黄群英 LIANG Zheng;LI Zhao-yu;HUANG Qun-ying(Department of Surgical Anesthesiology,the Second People′s Hospital of Neijiang,Neijiang 641000,Sichuan,China)

机构地区：[1]内江市第二人民医院手术麻醉科,四川省内江市641000

出　　处：《广西医学》2022年第24期2861-2865,共5页Guangxi Medical Journal

基　　金：四川省医学青年创新科研课题(Q19025)。

摘　　要：目的比较强度肺复张联合双肺通气或单肺通气对全腔镜食管癌根治术后患者肺功能的影响。方法将60例接受全腔镜食管癌根治术治疗的食管癌患者随机分为单肺通气组和双肺通气组,各30例。单肺通气组患者术中采用强度肺复张联合单肺通气,双肺通气组患者术中采用强度肺复张联合双肺通气。比较两组患者手术前后的肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))及FEV_(1)/FVC比值]、氧合指数、心率、平均动脉压(MAP),以及胸腔操作时间、手术时间、肺萎陷评分、胸导管拔管时间、术后并发症发生率。结果术后第2天,两组患者的FVC、FEV_(1)、FEV_(1)/FVC比值均低于术前,但是双肺通气组FVC、FEV_(1)、FEV_(1)/FVC比值均高于单肺通气组(均P<0.05)。术后第2天和第3天,双肺通气组的氧合指数高于单肺通气组(均P<0.05),两组的氧合指数均有随时间变化的趋势(P<0.05);两组的心率、MAP比较,差异均无统计学意义(均P>0.05),两组的心率、MAP均无随时间变化的趋势(均P>0.05)。两组患者的胸腔操作时间、手术时间比较,差异均无统计学意义(均P>0.05),而双肺通气组的肺萎陷评分、术后并发症发生率均低于单肺通气组,胸导管拔管时间短于单肺通气组(均P<0.05)。结论相比于强度肺复张联合单肺通气,强度肺复张联合双肺通气用于全腔镜食管癌根治术可有效维持食管癌患者的肺部氧合,快速实现肺萎陷,缩短胸导管拔管时间,从而有效改善患者的术后肺功能,减少术后并发症的发生。Objective To compare the effect of intensive lung recruitment combined with double-or single-lung ventilation on pulmonary function in patients after total endoscopic radical resection of esophageal carcinoma.Methods Sixty patients who received total endoscopic radical resection of esophageal carcinoma were randomly assigned to single-lung ventilation group or double-lung ventilation group,with 30 cases in each group.Patients in the single-lung ventilation group received intraoperative intensive lung recruitment combined with single-lung ventilation,whereas the double-lung ventilation group was employed intraoperative intensive lung recruitment combined with double-lung ventilation.The pre-and post-operation pulmonary function indicators(force vital capacity[FVC],forced expiratory volume in one second[FEV_(1)]and FEV_(1)/FVC ratio),and oxygenation index,heart rate and mean artery pressure(MAP),as well as duration of thoracic operation,operation duration,lung collapse score,extubation time for thoracic catheter and incidence rate of postoperative complications were compared between the two groups.Results On the second day after operation,compared with before operation,FVC,FEV_(1),and FEV_(1)/FVC ratio in the two groups were decreased after operation;however,the double-lung ventilation group exhibited higher aforesaid indicators as compared with the single-lung ventilation group(all P<0.05).On the second and third day after operation,oxygenation index in the double-lung ventilation group was higher than that in the single-lung ventilation group(all P<0.05),and it had tendency of changes over time in both groups(P<0.05);furthermore,no statistically significant difference in heart rate and MAP between the two groups(all P>0.05),and the heart rate and MAP of both groups depicted no trend of changes over time(all P>0.05).There was no statistically significant difference in duration of thoracic operation and operation duration between the two groups(all P>0.05),while the double-lung ventilation group yielded lower lung

关 键 词：食管癌 全腔镜食管癌根治术 强度肺复张 双肺通气 单肺通气 肺功能 

分 类 号：R735.1[医药卫生—肿瘤] R655.4[医药卫生—临床医学]