Ho A C Y, Chung H-S, Lu P-P, Hong C-L, Yang M-W, Liu H-P
Department of Anesthesia, Chang Gung Memorial Hospital, 5, Fu-shin Street, Kweishan, Taoyuan, 333, Taiwan.
Surg Endosc. 2004 Dec;18(12):1752-6. doi: 10.1007/s00464-003-9128-3. Epub 2004 Oct 13.
Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to medical response. Alternative uses of two- and one-lung ventilations have been required during VATS. This study evaluated the efficacy of alternating one- and two-lung ventilation through intraoperatively through the same single-lumen endobronchial tube using a tube exchanger during a thoracoscopic procedure for pediatric empyema.
Between May 1995 and August 2001, 62 consecutive pediatric patients undergoing VATS for evacuation of the loculated empyema cavity were studied. The same single-lumen endobronchial tube was used, with an indwelling endotracheal tube exchanger in place for readjustment of the tube position to provide alternation of one- and two-lung ventilations in a thoracosopic procedure. Duration of operation, heart rate, mean arterial pressure, peak airway pressure, an partial pressure of oxygen (PaO(2)) and carbon dioxide (PaCO(2)) changes during one- and two-lung ventilations were recorded. The quality of lung deflation and inflation was rated by the surgeon using direct visualization as excellent, fair or poor.
The mean operating time was 90 min (range, 50-120 min). No differences were found in heart rate, mean arterial pressure, or PaO(2) during one- and two-lung ventilations. Peak airway pressure and PaCO(2) during two-lung ventilation were significantly higher than during one-lung ventilation. The quality of lung deflation and inflation was judged excellent for all the patients.
The VATS procedure can be performed safely and effectively in children using proper anesthetic technique. Retention of a tube exchanger within a single-lumen endobronchial tube an easily provide alternative one- and two-lung ventilations without inducing any significant airway flow obstruction during the operation.
电视辅助胸腔镜手术（VATS）已成为治疗药物治疗无效的儿童肺炎后脓胸的一种创新且常用的方法。VATS手术过程中需要交替使用双肺通气和单肺通气。本研究评估了在小儿脓胸胸腔镜手术中，通过术中使用换管器经同一单腔支气管内导管交替进行单肺通气和双肺通气的效果。
1995年5月至2001年8月，对62例连续接受VATS手术以清除局限性脓胸腔的儿科患者进行了研究。使用同一单腔支气管内导管，并留置气管内换管器以重新调整导管位置，以便在胸腔镜手术中交替进行单肺通气和双肺通气。记录手术时间、心率、平均动脉压、气道峰压、单肺通气和双肺通气期间氧分压（PaO₂）和二氧化碳分压（PaCO₂）的变化。外科医生通过直接观察对肺萎陷和复张的质量进行评分，分为优、良、差。
平均手术时间为90分钟（范围50 - 120分钟）。单肺通气和双肺通气期间的心率、平均动脉压或PaO₂无差异。双肺通气时的气道峰压和PaCO₂显著高于单肺通气时。所有患者的肺萎陷和复张质量均评为优。
采用适当的麻醉技术，VATS手术可以在儿童中安全有效地进行。在单腔支气管内导管内保留换管器可以轻松提供交替的单肺通气和双肺通气，且在手术过程中不会引起任何明显的气道流量阻塞。
