经胸段食管癌切除术期间采用单肺通气还是双肺通气？

One-lung or two-lung ventilation during transthoracic oesophagectomy?

作者信息

Tachibana M, Abe S, Tabara H, Yoshimura H, Matsuura H, Nagasue N, Nakamura T

机构信息

Second Department of Surgery, Shimane Medical University, Izumo, Japan.

出版信息

Can J Anaesth. 1994 Aug;41(8):710-5. doi: 10.1007/BF03015626.

DOI:10.1007/BF03015626

PMID:7923519

Abstract

The purpose of this study was to determine the safety of one-lung ventilation (OLV) during transthoracic oesophagectomy. Changes in circulatory and respiratory variables during and after operation were compared in patients receiving OLV or conventional two-lung ventilation (TLV). Thirty patients undergoing transthoracic oesophagectomy were randomly divided into either the OLV or the TLV group. During thoracotomy, FIO2 was kept to 1.0. The PaO2 in the OLV group decreased from the prethoracotomy value of 467 +/- 84 mmHg to 227 +/- 162 mmHg during OLV. This decrease was greater than the decrease from 484 +/- 79 mmHg to 380 +/- 119 mmHg in the TLV group (P < 0.05). The shunt ratio increased in the OLV group from 20 +/- 7% to 35 +/- 13% during OLV which was greater than the increase in the TLV group (26 +/- 7% from 17 +/- 8%) (P < 0.05). Other variables and the incidence of the complications, however, were little different between the two groups during and after OLV and up to POD 3. It is concluded that OLV is as safe as TLV during oesophagectomy.

摘要

本研究的目的是确定经胸食管癌切除术中单肺通气（OLV）的安全性。比较接受OLV或传统双肺通气（TLV）的患者在手术期间及术后循环和呼吸变量的变化。30例行经胸食管癌切除术的患者被随机分为OLV组或TLV组。开胸手术期间，FiO₂维持在1.0。OLV组的PaO₂在OLV期间从开胸术前的467±84 mmHg降至227±162 mmHg。这种下降幅度大于TLV组从484±79 mmHg降至380±119 mmHg的幅度（P<0.05）。OLV组的分流率在OLV期间从20±7%增加到35±13%，大于TLV组的增加幅度（从17±8%增加到26±7%）（P<0.05）。然而，在OLV期间及术后直至术后第3天，两组之间的其他变量和并发症发生率几乎没有差异。得出的结论是，在食管癌切除术中OLV与TLV一样安全。