支气管封堵器在全腔镜中下段食管癌根治术中对围手术期心律失常及低氧血症的影响  

Effect of bronchial occluder on perioperative arrhythmia and hypoxemia in total cavity endoscopic radical resection of lower esophageal cancer

作　　者：陈海生 杨长刚 吴斌 CHEN Haisheng;YANG Changgang;WU Bin(Department of Thoracic Surgery,People's Hospital of Hai'an City,Hai'an 226600,China)

机构地区：[1]海安市人民医院胸外科,江苏海安226600

出　　处：《中国肿瘤外科杂志》2024年第3期271-275,共5页Chinese Journal of Surgical Oncology

基　　金：江苏省卫生健康委员会项目(LKM2022071)。

摘　　要：目的探讨支气管封堵器在全腔镜中下段食管癌根治术中对围手术期心律失常及低氧血症的影响。方法选取2020年9月至2022年9月海安市人民医院收治的84例全腔镜中下段食管癌根治术患者,采用随机数表法分为研究组(支气管封堵器,n=42例)和对照组(人工气胸,n=42例)。比较两组患者手术指标,即不同时间点[麻醉诱导前(T),麻醉诱导后5 min(T_(1)),肺通气后(T_(2))和术毕(T_(3))]的心率、平均动脉压、动脉氧分压、动脉二氧化碳分压以及心律失常、低氧血症的发生情况。结果研究组胸腔操作时间、拔管时间均短于对照组(P<0.05);两组患者心率、平均动脉压组间、时间、交互比较差异均有统计学意义(P<0.05),且研究组T_(2)时刻心率、平均动脉压均低于对照组(P<0.05)。两组患者动脉氧分压、二氧化碳分压组间、时间、交互比较差异均有统计学意义(P<0.05),且研究组T_(1)、T_(2)时刻动脉氧分压均高于对照组,二氧化碳分压低于对照组(P<0.05)。研究组心律失常和低氧血症发生率均低于对照组(P<0.05)。结论与人工气胸相比,支气管封堵器用于全腔镜中下段食管癌根治术患者能够减轻血流动力学波动,提高氧分压,减少心律失常、低氧血症的发生。Objective To explore the effect of bronchial occluder on perioperative arrhythmia and hypoxemia during total cavity endoscopic resection of lower esophageal cancer.Methods Eighty-four patients with middle and lower esophageal cancer treated by total cavity endoscopy in People's Hospital of Hai an City from September 2020 to September 2022 were randomly divided into a study group(bronchial occluder,n=42 cases)and a control group(artificial pneumothorax,n=42 cases).The operation indexes,heart rate,mean arterial pressure,arterial oxygen partial pressure at different time points[before anesthesia induction(T),5 minutes after anesthesia induction(T_(1)),after lung ventilation(T_(2))and after operation(T_(3))],and arrhythmia,hypoxemia were compared between the two groups.Results The operative time and extubation time of the thoracic cavity in the study group were shorter than those in the control group(P<0.05).There were statistically significant differences in heart rate,mean arterial pressure between groups,time and interaction(P<0.05).The heart rate and mean arterial pressure at T_(2) in the study group were lower than those in the control group(P<0.05).There were statistically significant differences between the two groups in terms of arterial oxygen partial pressure and CO 2 partial pressure(P<0.05),time and interaction(P<0.05),and the arterial oxygen partial pressure at T1 and T2 in the study group was higher than that in the control group,and the CO 2 fraction was lower than that in the control group(P<0.05).The incidence of arrhythmia and hypoxemia in the study group was lower than that in the control group(P<0.05).Conclusions Compared with artificial pneumothorax,bronchial occluder can reduce hemodynamic fluctuations,increase partial pressure of oxygen,and reduce the occurrence of arrhythmia and hypoxemia in patients undergoing radical resection of middle and lower esophageal cancer with total cavity mirror.

关 键 词：支气管封堵器 胸腔镜手术 腹腔镜手术 食管癌根治术 围手术期 心律失常 低氧血症 

分 类 号：R735.1[医药卫生—肿瘤]