Sun Y L, Bai Y, Li T K, Lü S G, Wang L, Lu X H
Department of Anesthesiology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China.
Zhonghua Yi Xue Za Zhi. 2017 Jul 25;97(28):2194-2197. doi: 10.3760/cma.j.issn.0376-2491.2017.28.007.
To investigate the effect of the single lumen endobronchial tube and the double lumen endobronchial tube on ventilation and lung injury in patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy. Sixty patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy were divided into single lumen endobronchial tube group (D group, =30) and double lumen endobronchial tube group (S, =30) according to the random number table. Blood samples were harvested at the moment of tracheal intubation (T(0)), after artificial pneumothorax (one lung ventilation) 30 min (T(1)), after artificial pneumothorax (one lung ventilation) 90 min (T(2)), artificial pneumothorax over (double lung ventilation) 30 min (T(3)) and after extubation 30 min (T(4)) for arterial blood gas analysis. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO(2)), oxygen tension (PaO(2)), carbon dioxide partial pressure (PaCO(2)) and airway pressure (PAW) were recorded at T(0)-T(4). The incidences of pneumonia of two groups were record at 3 days after operation. There were no obvious differences in HR, MAP, SpO(2), PaO(2), PaCO(2) between two groups at T(0)-T(4) (>0.05). Compared with T(0), the levels of HR and PaO(2) were increased remarkably at T(1)-T(3) (<0.05), the levels of PaCO(2) were increased remarkably at T(1)-T(4) (<0.01), and the levels of Paw were increased remarkably at T(1)-T(3) (<0.01). Compared with S group, the levels of Paw were decreased remarkably at T(1)-T(2) (29.5±3.7 vs 21.3±2.1, =0.001; 30.7±4.8 vs 20.3±2.3, =0.001). There were no obvious differences in the levels of TNF-α, IL-6, IL-8 in Bronchoalveolar Lavage Fluid (BALF) between two groups at T(0) (>0.05). Compared with T(0), the levels of TNF-α, IL-6, IL-8 in BALF were increased remarkably at T(3), T(5) (<0.05). Compared with S group, the levels of TNF-α, IL-6, IL-8 in D group in BALF were decreased remarkably at T(3), T(5) (<0.05). Compared with S group, the incidence of pneumonia in D group were decreased remarkably at 3 days after operation (4(13.3%) vs 11(36.7%), =0.017). The ventilation effect of the single lumen endobronchial tube on lung injury for patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy is the same as that of the double lumen endobronchial tube, however the single lumen endobronchial tube has less injury on the lung.
探讨单腔支气管导管与双腔支气管导管对食管癌同期行胸腔镜与腹腔镜联合食管癌切除术患者通气及肺损伤的影响。将60例行胸腔镜与腹腔镜联合食管癌切除术的患者，按随机数字表法分为单腔支气管导管组（D组，n = 30）和双腔支气管导管组（S组，n = 30）。于气管插管即刻（T(0)）、人工气胸（单肺通气）30 min后（T(1)）、人工气胸（单肺通气）90 min后（T(2)）、人工气胸结束（双肺通气）30 min后（T(3)）及拔管后30 min（T(4)）采集血样进行动脉血气分析。记录T(0) - T(4)时段的心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO(2)）、氧分压（PaO(2)）、二氧化碳分压（PaCO(2)）及气道压（PAW）。记录两组术后3 d肺炎的发生率。两组T(0) - T(4)时段HR、MAP、SpO(2)、PaO(2)、PaCO(2)比较，差异无统计学意义（P > 0.05）。与T(0)比较，T(1) - T(3)时段HR及PaO(2)水平显著升高（P < 0.05），T(1) - T(4)时段PaCO(2)水平显著升高（P < 0.01），T(1) - T(3)时段PAW水平显著升高（P < 0.01）。与S组比较，T(1) - T(2)时段D组PAW水平显著降低（29.5 ± 3.7 vs 21.3 ± 2.1，P = 0.001；30.7 ± 4.8 vs 20.3 ± 2.3，P = 0.001）。两组T(0)时段支气管肺泡灌洗液（BALF）中肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）水平比较，差异无统计学意义（P > 0.05）。与T(0)比较，T(3)、T(5)时段BALF中TNF-α、IL-6、IL-8水平显著升高（P < 0.05）。与S组比较，T(3)、T(5)时段D组BALF中TNF-α、IL-6、IL-8水平显著降低（P < 0.05）。与S组比较，D组术后3 d肺炎发生率显著降低（4(13.3%) vs 11(36.7%)，P = 0.017）。单腔支气管导管对食管癌同期行胸腔镜与腹腔镜联合食管癌切除术患者肺损伤的通气效果与双腔支气管导管相同，但单腔支气管导管对肺的损伤较小。
