单肺通气在新生儿胸腔镜手术中的应用

摘要

目的：探讨单肺通气在新生儿胸腔镜手术中的应用效果。方法择期行胸腔镜下食道重建术的先天性食道闭锁患儿60例，ASAⅡ或Ⅲ级，男31例，女29例，出生1-28d。随机均分为气管内插管组（A组）和支气管内插管组（B组）。麻醉诱导后，A组患儿在喉镜明视下完成气管插管，B组患儿在超纤细支气管内窥镜（Φ2.4mm）引导下完成普通气管导管的支气管内插管，其中左位主动脉弓者行左主支气管插管，反之，右位主动脉弓者行右主支气管插管，并于侧卧位后再次检查确认气管导管位置。记录两组患儿气管插管后5min（T0）和人工气胸后5min（T1）、10min（T2）、30min（T3）的HR、MAP、SpO2、PETCO2、RR、Pinsp、PEEP，并于上述各时点行动脉血气分析测得儿动脉血pH值、PaO2、PaCO2；评估两组患儿人工气胸后5min（T1）、10min（T2）的肺萎陷和手术野情况。结果 T1-T2时B组患儿SpO2、PaO2、肺萎陷和手术野评分均明显高于A组(P<0.05)。T3时两组患儿SpO2和PaO2差异无统计学意义。 T0-T3时两组患儿HR、MAP、PETCO2、RR、Pinsp、PEEP、动脉血pH值、PaCO2差异均无统计学意义。结论单肺通气用于新生儿胸腔镜手术，不仅安全可行，还可有效改善氧合，提高肺萎陷和手术野暴露程度。%Objective To investigate using ordinary endotracheal tube for endobronchial intubation of one-lung ventilation ap-plied to in the thoracoscopic surgery of neonates. Methods Sixty newborns(ASAⅡorⅢ,thirty one male,twenty nine female,age 1-28 days) undergoing the elective thoracoscopic surgery of neonatal congenital esophageal atresia were randomly divided into two groups (A and B). They were used ordinary endotracheal tube for tracheal intubation (A group,n=30),endobronchial intubation (B group,n=30) after intravenous anesthesia induction.induction. The following parameters were recorded:changes of HR,MAP,SpO2, PETCO2,RR,Pinsp,PEEP,arterial pH value,PaO2,PaCO2 at 5 min post-intubation,5min(T1),10min(T2),30min(T3) post-pneu-mothorax. At the time of 5min(T1),10min(T2) post-pneumothorax,recorded lung collapse scores. Results At T1-T2,SpO2,PaO2, lung collapse scores of group B were greatly higher than that in group A (P<0.05). At T3,there were no statisticaily significant dif-ferences between the two groups with SpO2 and PaO2. At T0-T3,there were no statisticaily significant differences between the two groups with HR,MAP,PETCO2,RR,Pinsp,PEEP,arterial pH value,PaCO2. Conclusion Not only safe and feasible,but also can effectively improve oxygenation,raise a collapsed lung and surgical field exposure,using ordinary endotracheal tube for endo-bronchial intubation of one-lung ventilation applied to in the thoracoscopic surgery of neonates.