不同麻醉通气方法在胸外科微创手术培训中的应用与比较  

Application and Comparison of Different Anesthetic Ventilation Methods in Minimally Invasive Thoracic Surgery Training

作　　者：刘意抒 赵善民 蔡丽萍 LIU Yishu;ZHAO Shanmin;CAI Liping(Medical Simulation Center of the Third Affiliated Hospital of Naval Medical University,Shanghai 200438,China;Department of Laboratory Animal Science,College of Basic Medical Sciences,Naval Medical University,Shanghai 200433,China;Clinical Education Center of the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第三附属医院医学模拟中心,上海200438 [2]海军军医大学基础医学院实验动物学教研室,上海200433 [3]海军军医大学第一附属医院临床教育中心,上海200433

出　　处：《实验动物与比较医学》2024年第1期97-104,共8页Laboratory Animal and Comparative Medicine

摘　　要：目的对比单肺通气和小潮气量双肺通气麻醉方法在实验猪胸外科微创手术培训中的应用效果和安全性。方法将40例接受手术机器人胸外科手术的实验猪随机分为双肺通气组(n=20)和单肺通气组(n=20)。双肺通气组施行单腔气管插管,术中使用小潮气量快呼吸频率联合二氧化碳气胸的麻醉通气方法。单肺通气组在纤维支气管镜引导下放置双腔支气管导管进行单肺通气。比较两组动物的麻醉实施指标,包括术中心率(heartrate,HR)、无创平均血压(meanbloodpressure,MAP)、呼气末二氧化碳(end-tidalcarbondioxide,ETCO_(2))和血氧饱和度(oxygensaturation,SpO_(2))等生命体征数值以及手术培训考核情况。结果两组动物的插管成功率均为100%,术中均无动物死亡。双肺通气组插管完成时间短于单肺通气组(P<0.001)。组内比较中,双肺通气组在胸科手术开始后30min(T_(1))和手术完成时(T_(3))的SpO_(2)含量显著高于手术开始60min(T_(2))(P<0.05),T_(2)和T_(3)的ETCO_(2)、HR和MAP显著高于T_(1)(P<0.05);单肺通气组中,T_(1)和T_(3)的SpO_(2)含量显著高于T_(2)(P<0.05),ETCO_(2)含量随时间逐渐上升(P<0.05)。在同一时间点的组间比较中,双肺通气组的SpO_(2)含量在所有时间点(T_(1)、T_(2)、T_(3))均显著高于单肺通气组(P<0.05)。结论单肺通气和双肺通气的麻醉方法都具有对术中动物生命体征的影响可控且对手术操作培训的影响较小的优点,皆可满足胸外科手术机器人培训需求。单肺通气在肺叶切除术中体验感更好,而使用小潮气量双肺通气的麻醉方法较单肺通气具有实施简便、无需额外购置设备的优点,可作为实验猪胸腔镜手术时的一种麻醉补充选择。Objective To compare the effectiveness and safety of one-lung ventilation and small tidal volume two-lung ventilation anesthesia methods in the training of minimally invasive thoracic surgery on experimental pigs.Methods Forty experimental pigs undergoing robotic thoracic surgery were randomly divided into two groups:two-lung ventilation group(n=20)and one-lung ventilation group(n=20).The two-lung ventilation group underwent single-lumen tracheal intubation,utilizing a small tidal volume with a fast respiratory rate combined with carbon dioxide pneumothorax for anesthesia ventilation during the operation.The one-lung ventilation group received one-lung ventilation using a double-lumen bronchial catheter placed under fiberoptic bronchoscopic guidance.The anesthesia implementation indexes from the two groups were compared,including the values of vital signs such as operative heart rate(HR),noninvasive mean blood pressure(MAP),end-tidal carbon dioxide(ETCO_(2)),and oxygen saturation(SpO_(2)),as well as the assessment of surgical training performance.Results The intubation success rate for animals in both groups was 100%,with no intraoperative deaths.The intubation completion time was significantly shorter in the two-lung ventilation group compared to the one-lung ventilation group(P<0.001).Within each group,SpO_(2)levels were significantly higher in the two-lung ventilation group at 30 minutes after the start of thoracic surgery(T_(1))and at surgery completion(T_(3))compared to 60 minutes after the start of surgery(T_(2))(P<0.05).ETCO_(2),HR,and MAP were significantly higher at T_(2) and T_(3) compared to T_(1)(P<0.05).In the one-lung ventilation group,SpO_(2)levels were significantly higher at T_(1) and T_(3) compared to T_(2)(P<0.05),while ETCO_(2)levels gradually increasing over time(P<0.05).In the between-group comparisons at the same time points,SpO_(2)levels of the two-lung ventilation group were significantly higher than those of the one-lung ventilation group at all time points(T_(1),T_(2),T_(3))(P<0.05).Con

关 键 词：实验猪 麻醉 胸腔镜手术 气道管理 手术机器人培训 

分 类 号：R-332[医药卫生]