单腔气管插管二氧化碳吹入人工气胸法在胸腔镜手术中的应用.doc

单腔气管插管二氧化碳吹入人工气胸法在胸腔镜手术中的应用 ? 286?ShanghaiMedJ,2006,Vol29-No5 论着 单腔气管插管二氧化碳吹人人工气胸法 在胸腔镜手术中的应用 周建华陈海泉孙艺华周贤罗晓阳 【摘要】目的分析应用单腔气管插管持续二氧化碳(CO2)吹人人工气胸对呼吸,循环的影响,评价其应用 于胸腔镜手术的安全性及可行性.方法对2O例采用单腔气管插管COz吹人人工气胸法行胸腔镜手术患者的 临床资料进行前瞻性分析,在低速充气(2～3I,/min),维持胸内压6～10mmHg(1mmHg一0.133kPa)的条件 下,监测中心静脉压(CVP),有创动脉压(ABP),心率,脉搏血氧饱合度(SpOz),气道压及呼气末COz分压(E- TCO2)等呼吸,循环指标和血气分析结果,观察其在COz充气前,后的变化趋势.结果COz吹人造成人工气胸 后,患者的心率,CVP,气道压,E—TCOz及cO2分压(PCOz)均有不同程度升高,血气pH值下降,但30min达到 稳定,不随时间延长而变化.并且停止充气5min后,所有指标均恢复至基础值水平.充气前,后ABP,Sp02及 02分压(PO2)始终无明显变化.所有病例均顺利完成胸腔镜手术,无严重并发症发生.结论单腔气管插管 CO2吹人人工气胸法是安全,有效且经济的方法,在临床胸腔镜手术中有一定的应用价值. 【关键词1COz吹入;胸腔镜手术 Applicationofasingle??lumenendotrachealintubationandcontinuouscarbondioxideinsufflationinvideo..assistedtho- racoscopicsurgeryZHOUJianhua,CHENHaiquan,SUNYihua,ZHOUXian,LUOXiaoyang.Departmentof CardiothoracicSurgery,ShanghaiSixthPeopleSHospital,ShanghaiJiaotongUniversity,Shanghai200233,China [Abstract]ObjectiveToevaluatethesafetyandfeasibilityofapplicationofasingle-lumenendotrachealin— tubationandcontinuouscarbondioxideinsufflationinvideo-assistedthoracoscopicsurgerybyprospectivelyanaly— zingtherespiratoryandcirculatoryeffectsofcarbondioxideinsufflation.Methods2Opatientsunderwentvideo-as— sistedthoracoscopicsurgeryusingsingle-lumenendotrachealintubationandcontinuouscarbondioxideinsufflation werestudied.MonitoringtheCVP,ABP,HR,SpOz,airwaypressure,andE-TC02unedrthemaintenanceofin— trapleuralpressureat6-10mmHgandinsufflationvelocity2-3L/min,comparedwiththoseofthechangesafterin— sufflation.ResultsAfterthecarbondioxideinsufflation,theCVP,HR,airwaypressure,E-TCO2,PCO2in— creasedandthepHvaluedecreased,allthemeasurementswerestabilizedin30minutesandreturnedtObaseline levelswithin5minutesafterterminationofinsufflation.TherewerenosignificantchangesinABP,Sr102,and P02aftertheinsufflation.Operativeprocedureswerecompletedsuccessfullyinallcaseswithoutseverecomplica— tions.ConclusionsThesingle-lumenendotrachealintubationandcontinuouscarbondioxideinsufflationisasafe, efficaciousandeconomict