Li Qiongzhen, Zhang Xiaofeng, Wu Jingxiang, Xu Meiying
Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China.
BMC Anesthesiol. 2017 Jun 15;17(1):80. doi: 10.1186/s12871-017-0371-x.
Thoracic surgery requires the effective collapse of the non-ventilated lung. In the majority of cases, we accomplished, accelerated lung collapse using a double-lumen tube (DLT). We hypothesized that using the two-minute disconnection technique with a DLT would improve lung collapse during subsequent one-lung ventilation.
Fifty patients undergoing thoracoscopic surgery with physical classification I or II according to the American Society of Anesthesiologists were randomly divided into two groups for respiratory management of one-lung ventilation (OLV). In group N, OLV was initiated after the DLT was disconnected for 2 min; the initiation time began when the surgeon made the skin incision. In group C, OLV was initiated when the surgeon commenced the skin incision and scored the quality of lung collapse (using a four-point ordinal scale). The surgeon's satisfaction or comfort with the surgical conditions was assessed using a visual analogue scale. rSO level, mean arterial pressure, pulse oxygen saturation, arterial blood gas analysis, intraoperative hypoxaemia, intraoperative use of CPAP during OLV, and awakening time were determined in patients at the following time points: while inhaling air (T), after anaesthesia induction andinhaling 100% oxygen in the supine position under double lung ventilation for five mins (T), at two mins after skin incision (T), at ten mins after skin incision (T), and after the lung recruitment manoeuvres and inhaling 50% oxygen for five mins (T).
The two-minute disconnection technique was associated with a significantly shorter time to total lung collapse compared to that of the conventional OLV ventilation method (15 mins vs 22 mins, respectively; P < 0.001), and the overall surgeon's satisfaction was higher (9 vs 7, respectively; P < 0.001). At T, the PaCO, left rSO and right rSO were higher in group N than in group C. There were no statistically significant differences between the incidence of intraoperative hypoxaemia and intraoperative use of CPAP during OLV (10% vs 5%, respectively; P = 1.000), duration of awakening (18 mins vs 19 mins, respectively; P = 0.616).
A two-minute disconnection technique using a double-lumen tube was used to speed the collapse of the non-ventilated lung during one-lung ventilation for thoracoscopic surgery. The surgeon was satisfied with the surgical conditions.
Chinese Clinical Trial Registry number, ChiCTR-IPR-17010352 . Registered on Jan, 7, 2017.
胸外科手术需要使非通气肺有效萎陷。在大多数情况下，我们使用双腔管（DLT）实现并加速肺萎陷。我们推测，在双腔管使用两分钟断开技术将改善随后单肺通气期间的肺萎陷情况。
根据美国麻醉医师协会身体状况分级为I或II级的50例行胸腔镜手术患者被随机分为两组进行单肺通气（OLV）的呼吸管理。在N组中，DLT断开2分钟后开始OLV；开始时间从外科医生切开皮肤时算起。在C组中，外科医生开始切开皮肤时开始OLV，并对肺萎陷质量进行评分（采用四点顺序量表）。使用视觉模拟量表评估外科医生对手术条件的满意度或舒适度。在以下时间点测定患者的rSO₂水平、平均动脉压、脉搏血氧饱和度、动脉血气分析、术中低氧血症、OLV期间术中使用持续气道正压通气（CPAP）情况以及苏醒时间：吸入空气时（T₁）、麻醉诱导后双肺通气下仰卧位吸入100%氧气5分钟后（T₂）、皮肤切开后2分钟（T₃）、皮肤切开后10分钟（T₄）以及肺复张操作后吸入50%氧气5分钟后（T₅）。
与传统OLV通气方法相比，两分钟断开技术使全肺萎陷时间显著缩短（分别为15分钟和22分钟；P < 0.001），并且外科医生的总体满意度更高（分别为9分和7分；P < 0.001）。在T₃时，N组的动脉血二氧化碳分压（PaCO₂）、左rSO₂和右rSO₂高于C组。OLV期间术中低氧血症发生率和术中使用CPAP情况之间无统计学显著差异（分别为10%和5%；P = 1.000），苏醒持续时间也无显著差异（分别为18分钟和19分钟；P = 0.616）。
在胸腔镜手术单肺通气期间，使用双腔管的两分钟断开技术可加速非通气肺的萎陷。外科医生对手术条件感到满意。
中国临床试验注册中心编号，ChiCTR-IPR-17010352。于2017年1月7日注册。
