McGrath Brendan, Tennuci Christopher, Lee George
Anaesthetics and Intensive Care Unit, Wythenshawe Hospital, Southmoor Rd, Manchester, M23 9LT, United Kingdom.
J Anesth Hist. 2017 Jul;3(3):76-86. doi: 10.1016/j.janh.2017.05.002. Epub 2017 May 31.
One-lung anesthesia presents many practical, anatomical, and physiological challenges to the anesthetist in modern day practice. The techniques and equipment that we use today have developed slowly over the course of the last century. The idea of isolated lung ventilation came from bronchospirometry studies by pioneering physiologists as early as 1871, and some of their original equipment was adapted for clinical use in the 1930s. Anesthetic techniques have generally been developed to facilitate surgical advances, and the development of double-lumen tubes is no exception. The development of the double-lumen tube was sporadic and occurred mainly to allow more complex thoracic procedures, mostly associated with suppurative lung disease. Once the need for independent ventilation of the lungs was identified in clinical practice, pioneers of the technique developed their own methods and often their own equipment. This led to the ability of the anesthetist to be able to control ventilation to each lung, including collapse of the operative lung and protection of the isolated lung against contamination. As these anesthetics became more reliable, the surgical scope for one-lung anesthesia began to broaden, and today one-lung ventilation is used to facilitate thoracic surgery, mainly on the lung, but also esophageal, thoracic wall, and mediastinal surgical procedures.
在现代麻醉实践中，单肺麻醉给麻醉医生带来了诸多实际、解剖学和生理学方面的挑战。我们如今所使用的技术和设备在上个世纪的进程中发展缓慢。早在1871年，开创性的生理学家通过支气管肺量计研究提出了单肺通气的概念，他们的一些原始设备在20世纪30年代被改编用于临床。麻醉技术的发展总体上是为了促进外科手术的进步，双腔管的发展也不例外。双腔管的发展是零星的，主要是为了便于进行更复杂的胸部手术，大多与化脓性肺部疾病相关。一旦在临床实践中确定了对双肺独立通气的需求，该技术的先驱者们便开发了他们自己的方法，并且常常是他们自己的设备。这使得麻醉医生能够控制对每个肺的通气，包括使手术侧肺萎陷以及保护隔离的肺免受污染。随着这些麻醉方法变得更加可靠，单肺麻醉的手术范围开始扩大，如今单肺通气被用于促进胸部手术，主要是肺部手术，但也包括食管、胸壁和纵隔的外科手术。
