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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

35

期数:

2018年7

页码:

592-596

栏目:

临床研究

出版日期:

2018-07-05

文章信息/Info

Title:

Protective effect of single-lumen endotracheal intubation and continuous carbon dioxide artificial pneumothorax on the lung of patients undergoing thoracoscopic and laparoscopic radical esophagectomy

作者:

申帅辉¹; 王　玲²; 郝　文¹; 毛英杰²

（1.新乡医学院，河南　新乡　453003；2.中国人民解放军第150中心医院麻醉科，河南　洛阳　471031）

Author(s):

SHEN Shuai-hui¹; WANG Ling²; HAO Wen¹; MAO Ying-jie²

（1.Xinxiang Medical University，Xinxiang 453003，Henan Province，China；2.Department of Anesthesia，the 150^th Central Hospital of the Chinese PLA，Luoyang 471031，Henan Province，China）

关键词:

食管癌; 人工气胸; 胸腹腔镜; 单腔气管插管

Keywords:

esophageal cancer; artificial pneumothorax; thoracoscopy and laparoscopy; single-lumen endotracheal intubation

分类号:

R735.1R614

DOI:

10.7683/xxyxyxb.2018.07.011

文献标志码:

A

摘要:

目的　观察单腔气管插管二氧化碳人工气胸对行胸腹腔镜食管癌根治术患者的肺保护作用。方法　选择2016年12月至2017年6月于中国人民解放军第150中心医院择期行胸腹腔镜食管癌根治术患者60例，采用随机数字表法分为观察组和对照组，每组30例。观察组患者采用单腔气管插管后持续注入二氧化碳气体建立手术侧人工气胸，术中持续进行双肺通气；对照组患者采用双腔气管插管后断开术侧肺通气，术中进行非术侧肺单肺通气，胸腔操作完成后恢复双侧肺正常通气；分别于气管插管前（T₀）、观察组建立人工气胸/对照组单肺通气30 min（T₁）、观察组建立人工气胸/对照组单肺通气60 min（T₂）、观察组人工气胸结束后/对照组双肺通气30 min（T₃）、手术结束时（T₄）采集患者的颈内静脉血，采用酶联免疫吸附试验法测定血清中白细胞介素-4（IL-4）、IL-6、IL-8、IL-10、肿瘤坏死因子-α（TNF-α）水平；并记录2组患者T₀、T₁、T₂、T₃、T₄时的血氧饱和度（SpO₂）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）及气道峰压（Ppeak）；比较2组患者术后3 d肺不张、肺部感染、低氧血症的发生率。结果　T₀时2组患者血清IL-4、IL-6、IL-8、IL-10、TNF-α水平比较差异均无统计学意义（P>0.05）；2组患者T₁、T₂、T₃、T₄时血清IL-4、IL-6、IL-8、IL-10、TNF-α水平显著高于T₀时（P<0.05）；与对照组比较，观察组患者T₁、T₂、T₃、T₄时血清IL-6、IL-8、TNF-α水平显著降低（P<0.05），IL-4、IL-10水平显著升高（P<0.05）。T₀时2组患者SpO₂、PaO₂、PaCO₂比较差异均无统计学意义（P>0.05）。T₁、T₂、T₃、T₄时2组患者SpO₂比较差异均无统计学意义（P>0.05）；T₁、T₂时观察组患者PaO₂、PaCO₂显著高于对照组（P<0.05），但T₃、T₄时2组患者PaO₂、PaCO₂比较差异无统计学意义（P>0.05）；T₁、T₂、T₃、T₄时观察组患者Ppeak显著低于对照组（P<0.05）。2组患者手术时间、术中出血量比较差异均无统计学意义（P>0.05）。术后3 d，对照组和观察组患者并发症发生率分别为36.7%（11/30）和16.7%（5/30），观察组患者术后3 d并发症发生率显著低于对照组（χ²=7.040，P<0.05）。结论　单腔气管插管二氧化碳人工气胸对行胸腹腔镜食管癌根治术患者肺损伤小，具有更好的肺保护作用。

Abstract:

Objective　To investigate the protective effect of single-lumen endotracheal intubation and continuous carbon dioxide artificial pneumothorax on the lung of patients undergoing thoracoscopic and laparoscopic radical esophagectomy.Methods　A total of 60 patients who underwent thoracoscopic and laparoscopic radical esophagectomy in the 150^th Central Hospital of the Chinese PLA from December 2016 to June 2017 were selected as the research subjects.The patients were divided into observation group（single-lumen endotracheal intubation and continuous carbon dioxide artificial pneumothorax） and control group（double-lumen tracheal intubation and single lung ventilation） by random digits table method，30 cases in each group.The patients in the observation group underwent single-lumen tracheal intubation and artificial pneumothorax by continuous injection of carbon dioxide gas，and the double lung ventilation was continued during the operation.The patients in the control group were treated with double-lumen tracheal intubation，and the operating side lung ventilation was disconnected after tracheal intubation，and the non-operating side lung ventilation was performed during the operation，and the bilateral lung ventilation was restored after the thoracic operation.The internal jugular vein blood of the patients was collected at the time points of before tracheal intubation （T₀），artificial pneumothorax establishment in the observation group or single lung ventilation in the control group for 30 min （T₁），artificial pneumothorax establishment in the observation group or single lung ventilation in the control group for 60 min （T₂），30 min after artificial pneumothorax in the observation group or double lung ventilation in the control group （T₃），and the end of the operation （T₄）.The levels of serum interleukin-4 （IL-4），IL-6，IL-8，IL-10 and tumor necrosis factor-α （TNF-α） were detected by enzyme linked immunosorbent assay （ELISA）.The pulse oxygen saturation （SpO₂），arterial oxygen partial pressure （PaO₂），arterial blood carbon dioxide pressure （PaCO₂） and airway pressure peak （Ppeak） of the patients in the two groups were recorded at the time points of T₀，T₁，T₂，T₃ and T₄.The incidences of atelectasis，pulmonary infection and hypoxemia within three days after operation were compared between the two groups.Results　There was no significant difference in serum IL-4，IL-6，IL-8，IL-10 and TNF-α levels between the two groups at T₀ （P>0.05）.The levels of serum IL-4，IL-6，IL-8，IL-10 and TNF-α at T₁，T₂，T₃ and T₄ were significantly higher than those at T₀ in the two groups （P<0.05）.The levels of serum IL-6，IL-8 and TNF-α in the observation group were significantly lower than those in the control group at T₁，T₂，T₃ and T₄ （P<0.05）；and the levels of serum IL-4 and IL-10 in the observation group were significantly higher than those in the control group at T₁，T₂，T₃ and T₄ （P<0.05）.There was no significant difference in the SpO₂，PaO₂ and PaCO₂ between the two groups at T₀ （P>0.05）.There was no significant difference in SpO₂ between the two groups at T₁，T₂，T₃ and T₄ （P>0.05）.The PaO₂ and PaCO₂ in the observation group were significantly higher than those in the control group at T₁ and T₂ （P<0.05）.There was no significant difference in PaO₂ and PaCO₂ between the two groups at T₃ and T₄ （P>0.05）.The Ppeak in the observation group was significantly lower than that in the control group at T₁，T₂，T₃ and T₄ （P<0.05）.There was no significant difference in operation time and intraoperative bleeding between the two groups （P>0.05）.With three days after operation，the incidence of complications in the control group and the observation group was 36.7% （11/30） and 16.7% （5/30） respectively，the incidence of complications in the observation group was significantly lower than that in the control group （χ²=7.040，P<0.05）.Conclusion　Single-lumen endotracheal intubation and continuous carbon dioxide artificial pneumothorax in thoracoscopic and laparoscopic radical esophagectomy has less pulmonary injury and better pulmonary protection.

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更新日期/Last Update: 2018-07-05