胸腔镜下肺大疱切除术治疗原发性自发性气胸：采用低潮气量双肺通气麻醉

Thoracoscopic bleb resection using two-lung ventilation anesthesia with low tidal volume for primary spontaneous pneumothorax.

作者信息

Kim Heezoo, Kim Hyun Koo, Choi Young Ho, Lim Sang Ho

机构信息

Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

出版信息

Ann Thorac Surg. 2009 Mar;87(3):880-5. doi: 10.1016/j.athoracsur.2008.12.071.

DOI:10.1016/j.athoracsur.2008.12.071

PMID:19231412

Abstract

BACKGROUND

We performed thoracoscopic surgery for pneumothorax using two-lung ventilation with low tidal volume and evaluated the feasibility and safety of this procedure.

METHODS

Forty-six patients (mean age, 23.6 +/- 10.47 years) each with a primary spontaneous pneumothorax underwent wedge resection with chemical and mechanical pleurodesis. Two-lung ventilation anesthesia was performed with a single-lumen endotracheal tube, and the tidal volume was reduced to 4 mL/kg; the respiratory rate was increased to 24 cycles/min. Airway pressure, end-tidal CO(2), and the results of blood gas analysis were obtained right after endotracheal intubation and during the operation, and were compared.

RESULTS

The tidal volume was 496.2 +/- 94.33 mL at anesthesia induction, which decreased to 243.9 +/- 34.43 mL during the two-lung ventilation. In 5 patients, the tidal volume was additionally decreased by 32.5 +/- 12.58 mL (p = 0.014) to obtain an optimal working field. The differences between the airway pressure, pH, partial pressure of carbon dioxide, and partial pressure of oxygen were significant between the two measurement times. However, all of the values of the arterial blood gas analysis were within normal range. The oxygen saturation (99.9% +/- 0.69% versus 99.8 +/- 0.72%; p = 0.160) and end-tidal CO(2) (33.2 +/- 3.74 mm Hg versus 34.1 +/- 4.19 mm Hg; p = 0.157) were not significantly different. The time from intubation before the incision was 17.1 +/- 4.18 minutes, the operation time was 31.9 +/- 14.48 minutes, and the total anesthesia time was 65.8 +/- 15.02 minutes.

CONCLUSIONS

Thoracoscopic surgery for primary spontaneous pneumothorax using two-lung ventilation with low tidal volume was technically feasible.

摘要

背景

我们采用低潮气量双肺通气进行胸腔镜气胸手术，并评估了该手术的可行性和安全性。

方法

46例原发性自发性气胸患者（平均年龄23.6±10.47岁）接受了楔形切除术及化学和机械性胸膜固定术。采用单腔气管内导管进行双肺通气麻醉，潮气量降至4 mL/kg；呼吸频率增至24次/分钟。在气管插管后及手术期间获取气道压力、呼气末二氧化碳分压及血气分析结果，并进行比较。

结果

麻醉诱导时潮气量为496.2±94.33 mL，双肺通气时降至243.9±34.43 mL。5例患者的潮气量额外减少了32.5±12.58 mL（p = 0.014）以获得最佳手术视野。两个测量时间点的气道压力、pH值、二氧化碳分压和氧分压差异显著。然而，所有动脉血气分析值均在正常范围内。氧饱和度（99.9%±0.69%对99.8±0.72%；p = 0.160）和呼气末二氧化碳分压（33.2±3.74 mmHg对34.1±4.19 mmHg；p = 0.157）无显著差异。切开前插管时间为17.1±4.18分钟，手术时间为31.9±14.48分钟，总麻醉时间为65.8±15.02分钟。