传统开胸肺叶切除术和胸腔镜肺叶切除术对肺癌患者血流动力学的影响比较

摘要

Objective To compare the effects of conventional thoracotomy and video-assisted thoracoscopic lobectomy on intraoperative hemodynamics of patients with lung carcinoma.Methods Twenty-nine patients with lung cancer ASA Ⅰor Ⅱ were divided into two groups:13 cases in the control group undergoing conventional thoracotomy,16 cases in the observation group undergoing video-assisted thoracoscopic lobectomy.The heart rate (HR),mean arterial pressure (MAP),cardiac output(CO),cardiac index (CI),stroke volume (SV),stroke volume variation(SVV) at horizontal position after induction of anesthesia (T1),side-lying position before opening chest (T2),at the moment of one lung ventilation(T3),10 min after one lung ventilation before opening chest(T4),30 min after one lung ventilation before opening chest(T5),60 min after one lung ventilation before opening chest (T6),at the end of one lung ventilation (T7),at the end of operation (T8) were recorded.And the number of hypertension,hypotension,nodal tachycardia,sinus bradycardia,arrhythmia occurrences in all patients was recorded.Results Intraoperative hemodynamics of two groups changed with time,but no difference was found between the two groups (P ＞ 0.05).There were no statistically significant differences in HR,MAP,CO,CI,SV and SVV between the two groups at the same time (all P ＞ 0.05).The number of hypotension,nodal tachycardia,sinus bradycardia happened in the two groups was not statistically different (all P ＞ 0.05),but the number of hypertension and arrhythmia in the observation group was decreased compared with the control group(P ＜ 0.05).Conclusion Compared with the conventional thoracotomy,no differences were found in hemodynamics during video-assisted thoracoscopic lobectomy,but incidence rates of hypertension and arrhythmia were low.%目的 比较传统开胸肺叶切除术和胸腔镜肺叶切除术对肺癌患者血流动力学的影响.方法 选择肺癌患者29例,ASA分级Ⅰ～Ⅱ级,其中择期行传统开胸肺叶切除术13例(对照组)、胸腔镜肺叶切除术16例(观察组).两组入手术室后均使用FloTrac/Vigileo系统,记录麻醉诱导后平卧位(T1)、开胸前侧卧位(T2)、单肺通气即刻(T3)、单肺通气后10 min(T4)、单肺通气后30 min(T5)、单肺通气后60 min(T6)、单肺通气结束(T7)、手术结束(T8)的心率(HR)、平均动脉压(MAP)、心输出量(CO)、心指数(CI)、每搏量(SV)、每搏量变异度(SVV),记录患者术中出现心血管事件的次数.结果 两组术中血流动力学指标均随时间而变化,但术中同一时点的HR、MAP、CO、CI、SV、SVV比较均无统计学差异(P均＞0.05).两组术中出现低血压、窦速、窦缓的次数均无统计学差异(P均＞0.05),观察组出现高血压的次数较对照组少(P＜0.05).结论 与行传统开胸肺叶切除术的肺癌患者相比,行胸腔镜肺叶切除术者的血流动力学变化无差异,但高血压和心律失常发生次数减少.