Surgical Center, Saga Medical School Hospital, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga city, Saga, 849-8501, Japan.
Intensive Care Unit, Faculty of Medicine, Saga Medical School Hospital, Saga University, Saga, Japan.
Sci Rep. 2021 Mar 26;11(1):6978. doi: 10.1038/s41598-021-86554-y.
We aimed to clarify the changes in respiratory mechanics and factors associated with them in artificial pneumothorax two-lung ventilation in video-assisted thoracoscopic esophagectomy in the prone position (PP-VATS-E) for esophageal cancer. Data of patients with esophageal cancer, who underwent PP-VATs-E were retrospectively analyzed. Our primary outcome was the change in the respiratory mechanics after intubation (T1), in the prone position (T2), after initiation of the artificial pneumothorax two-lung ventilation (T3), at 1 and 2 h (T4 and T5), in the supine position (T6), and after laparoscopy (T7). The secondary outcome was identifying factors affecting the change in dynamic lung compliance (Cdyn). Sixty-seven patients were included. Cdyn values were significantly lower at T3, T4, and T5 than at T1 (p < 0.001). End-expiratory flow was significantly higher at T4 and T5 than at T1 (p < 0.05). Body mass index and preoperative FEV were found to significantly influence Cdyn reduction during artificial pneumothorax and two-lung ventilation (OR [95% CI]: 1.29 [1.03-2.24] and 0.20 (0.05-0.44); p = 0.010 and p = 0.034, respectively]. Changes in driving pressure were nonsignificant, and hypoxemia requiring treatment was not noted. This study suggests that in PP-VATs-E, artificial pneumothorax two-lung ventilation is safer for the management of anesthesia than conventional one-lung ventilation (UMIN Registry: 000042174).
我们旨在阐明在食管癌俯卧位胸腔镜辅助食管切除术（PP-VATS-E）中，人工气胸双肺通气时呼吸力学的变化及其相关因素。回顾性分析了行 PP-VATS-E 的食管癌患者的数据。我们的主要结局是插管后（T1）、俯卧位（T2）、人工气胸双肺通气开始后（T3）、1 小时和 2 小时（T4 和 T5）、仰卧位（T6）和腹腔镜检查后（T7）的呼吸力学变化。次要结局是确定影响动态肺顺应性（Cdyn）变化的因素。共纳入 67 例患者。与 T1 相比，T3、T4 和 T5 的 Cdyn 值显著降低（p<0.001）。T4 和 T5 的呼气末流量显著高于 T1（p<0.05）。BMI 和术前 FEV 被发现显著影响人工气胸和双肺通气期间 Cdyn 的减少（OR[95%CI]：1.29[1.03-2.24]和 0.20（0.05-0.44）；p=0.010 和 p=0.034）。驱动压的变化无统计学意义，也未出现需要治疗的低氧血症。本研究表明，在 PP-VATS-E 中，与传统单肺通气相比，人工气胸双肺通气在麻醉管理方面更安全（UMIN 注册表：000042174）。
