Khasag Narmisheekh, Sakiyama Shoji, Toba Hiroaki, Yoshida Mitsuteru, Nakagawa Yasushi, Takizawa Hiromitsu, Kawakami Yukikiyo, Kenzaki Koichiro, Ali Abdellah Hamed Khalil, Kondo Kazuya, Tangoku Akira
Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School, Tokushima, Japan.
Eur J Cardiothorac Surg. 2014 Mar;45(3):531-6. doi: 10.1093/ejcts/ezt395. Epub 2013 Aug 2.
Carbon monoxide (CO) is expelled mainly via the lungs, so that exhaled carbon monoxide (Ex-CO) concentration reflects endogenous production. Recent reports have shown that Ex-CO levels are increased in critically ill patients and after anaesthesia and surgery. However, there has been no investigation of the changes in Ex-CO level during a lung operation. We continuously monitored Ex-CO and exhaled carbon dioxide (Ex-CO2) concentrations during surgery for lung cancer.
Eighteen lung cancer patients who underwent elective lung cancer lobectomy were enrolled in this study. All patients were endotracheally intubated and ventilated under general anaesthesia. Ex-CO and Ex-CO2 concentrations were separately monitored and recorded continuously using two sets of Carbolyzer® breath analysers (Taiyo Inc., Osaka, Japan).
Ex-CO concentration increased rapidly in response to changes in body position from supine to decubitus and was significantly decreased when patients were once again lying back (supine 2). Upon restarting bilateral ventilation, Ex-CO concentration in the operated lung was significantly higher than that in the breathing lung. In the lateral decubitus position, Ex-CO2 concentration showed the same pattern of increase as seen for Ex-CO. In the operated lung, the Ex-CO2 concentrations changed significantly at clamping, declamping and supine 2. In the re-ventilated, operated lung, the Ex-CO2 concentration was significantly lower than in the breathing lung. In the breathing lung, the Ex-CO2 concentration did not exhibit any significant changes over the course of the operation.
When breathing was restarted, the Ex-CO level of the target lung was significantly higher than that of the breathing lung. The Ex-CO concentration was also affected by the surgical body position and this change was marked and transient.
一氧化碳（CO）主要通过肺部排出，因此呼出一氧化碳（Ex-CO）浓度反映内源性生成情况。近期报告显示，危重症患者以及麻醉和手术后呼出一氧化碳水平会升高。然而，尚未有关于肺手术期间呼出一氧化碳水平变化的研究。我们在肺癌手术期间持续监测呼出一氧化碳和呼出二氧化碳（Ex-CO₂）浓度。
本研究纳入了18例行择期肺癌肺叶切除术的患者。所有患者均在全身麻醉下经气管插管并进行机械通气。使用两套Carbolyzer®呼气分析仪（日本大阪太阳公司）分别连续监测并记录呼出一氧化碳和呼出二氧化碳浓度。
随着体位从仰卧位变为侧卧位，呼出一氧化碳浓度迅速升高，当患者再次仰卧（仰卧2）时显著下降。重新开始双侧通气时，术侧肺的呼出一氧化碳浓度显著高于健侧肺。在侧卧位时，呼出二氧化碳浓度呈现出与呼出一氧化碳相同的升高模式。在术侧肺，呼出二氧化碳浓度在夹闭、松开夹子和仰卧2时发生显著变化。在重新通气的术侧肺中，呼出二氧化碳浓度显著低于健侧肺。在健侧肺中，呼出二氧化碳浓度在手术过程中未出现任何显著变化。
重新开始呼吸时，目标肺的呼出一氧化碳水平显著高于健侧肺。呼出一氧化碳浓度也受手术体位影响，且这种变化明显且短暂。
