Ren Yun, Lyu Yi, Yu Ying, Jin Lin, Hu Yan, Guo Kefang, Cang Jing
Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Anesthesia, Minhang Hospital, Fudan University, Shanghai, China.
Ann Transl Med. 2021 Feb;9(3):254. doi: 10.21037/atm-20-986.
Minimally invasive cardiac surgery (MICS) is increasingly performed due to faster recovery time and lower postoperative complications when compared with the traditional open surgery. However, hypoxemia in lung isolation duration after cardiopulmonary bypass (CPB) surgery has been the focus of anesthesiologists' attention. In the present study, we designed a novel lung isolation strategy to improve oxygenation using a bronchial blocker (BB) to isolate the right middle and lower lobes and preserve the ventilated right upper lobe without affecting the surgical field.
Patients who had undergone right lateral mini-thoracotomy, a MICS, between August 2018 and February 2019, were enrolled in this randomized controlled study. Patients were randomly divided into a modified lung isolation group (group M) and a conventional lung isolation group (group C). In group M, BBs were used to block the bronchus intermedius, while left-sided double lumen endotracheal tubes were used in group C to isolate the right lung. The primary outcome was to determine the number of patients who required an increase in ventilation volume due to hypoxemia during lung isolation after CPB.
Sixty-one patients (30 in group C and 31 in group M) were enrolled. Five patients in group M were converted to right lung isolation due to poor surgical field exposure. During lung isolation after CPB, the number of patients with hypoxemia was lower in group M than group C (5/31 . 15/30, P=0.005).
The novel modified lung isolation strategy reduced the incidence of hypoxemia after CPB.
与传统的开放手术相比，微创心脏手术（MICS）因恢复时间更快、术后并发症更低而越来越多地被采用。然而，体外循环（CPB）手术后肺隔离期间的低氧血症一直是麻醉医生关注的焦点。在本研究中，我们设计了一种新颖的肺隔离策略，使用支气管封堵器（BB）隔离右中、下叶，保留通气的右上叶，同时不影响手术视野，以改善氧合。
纳入2018年8月至2019年2月期间接受右侧小切口开胸手术（一种MICS）的患者进行这项随机对照研究。患者被随机分为改良肺隔离组（M组）和传统肺隔离组（C组）。在M组中，使用BB封堵中间支气管，而C组使用左侧双腔气管导管隔离右肺。主要结局是确定CPB后肺隔离期间因低氧血症需要增加通气量的患者数量。
共纳入61例患者（C组30例，M组31例）。M组有5例患者因手术视野暴露不佳而改为右肺隔离。CPB后肺隔离期间，M组低氧血症患者数量低于C组（5/31对15/30，P = 0.005）。
新型改良肺隔离策略降低了CPB后低氧血症的发生率。
