预先单肺通气联合呼吸暂停对支气管封堵器用于胸腔镜手术单肺通气时肺萎陷的影响

Effect of preemptive one lung ventilation combined with disconnection technique on lung collapse during one lung ventilation with bronchial blocker in thoracoscopic surgery

摘要:

目的 探讨预先单肺通气（OLV）联合呼吸暂停对支气管封堵器（BB）用于胸腔镜手术行OLV时肺萎陷的影响。方法 选择择期行胸腔镜下左肺段或肺叶切除术的患者75例，随机分为预先OLV组（A组）、呼吸暂停组（B组）和预先OLV联合呼吸暂停组（C组），每组25例。记录3组打开胸膜到肺完全萎陷的时间、外科医生满意度、进胸前准备时间、OLV时间、手术时间和OLV开始至胸膜打开后20 min内低氧血症［经皮动脉血氧饱和度（SpO₂） < 90%］的发生情况；记录3组胸膜腔开放即刻（T₀）、胸膜腔开放后1 min（T₁）、5 min（T₂）、10 min（T₃）和20 min（T₄）的肺萎陷评分（LCS）。结果 与A组和B组比较，C组肺完全萎陷时间明显缩短，外科医生满意度明显提高，差异均有统计学意义（P < 0.05），A组和B组肺完全萎陷时间和外科医生满意度比较，差异均无统计学意义（P > 0.05）；与A组比较，B组T₀时点LCS低于A组，而在T₁时点，则明显高于A组，C组T₁、T₂、T₃和T₄时点LCS明显高于A组和B组，差异均有统计学意义（P < 0.05）；C组T₂时点SpO₂明显低于A组和B组，差异有统计学意义（P < 0.05）。结论 对于用BB行OLV的胸腔镜手术患者，预先使用OLV联合呼吸暂停，可以改善非通气侧肺的肺萎陷效果，缩短了肺完全萎陷时间，提高了外科医生满意度，且OLV的早期LCS更高，但仍需监测OLV期间的SpO₂。

Abstract:

Objective To investigate the efficacy and safety of preemptive one lung ventilation (OLV) combined with disconnection technique for lung collapse during OLV with bronchial blocker(BB) in thoracoscopic surgery.Methods 75 patients who were scheduled for elective left lung segment or lobectomy under thoracoscopy were randomly divided into preemptive OLV group (group A), disconnection technique group (group B) and preemptive OLV combined with disconnection technique (group C), 25 cases in each group. The time of complete lung collapse, surgeon satisfaction, pre-thoracic preparation time, OLV time, operation time, and occurrence of hypoxemia [percutaneous arterial oxygen saturation (SpO₂) < 90%] within 20 minutes after the onset of OLV were recorded; The lung collapse score (LCS) at the moment of pleural cavity opening (T₀), 1 min (T₁), 5 min (T₂), 10 min (T₃) and 20 min (T₄) after pleural cavity opening were recorded.Results Compared with group A and B, the complete lung collapse time in Group C was significantly shortened, and the surgeon satisfaction was significantly improved, the differences were statistically significant (P < 0.05). There was no statistical significance in the complete lung collapse time and surgeon satisfaction between group A and B, the differences were not statistically significant (P > 0.05). Compared with group A, the LCS at T₀ in group B was lower than that in group A, but significantly higher at T₁, the differences were statistically significant (P < 0.05). The LCS at T₁, T₂, T₃ and T₄ in group C were significantly higher than those in group A and group B, the differences were statistically significant (P < 0.05). The value of SpO₂ at T₂ in group C was obviously lower than that in group A and group B, the difference was statistically significant (P < 0.05).Conclusion Preemptive OLV combined with disconnection technique can improve the lung collapse of the non-ventilated lung during OLV with BB in thoracoscopic surgery, shorten complete lung collapse time, with higher surgeon satisfaction, and higher LCS score during OLV. However, SpO₂ during OLV still needs to be monitored.