20例肺癌胸腔镜下肺叶切除术的麻醉

Anaesthesia experience of 20 cases of pulmonary lobectomy by VATS in treatment of lung cancer

关键词:  胸腔镜（VATS）  单肺通气  低氧血症

Key words:  VATS  one-lung ventilation  hypoxemia

摘要:

［目的］ 总结20例肺癌胸腔镜下肺叶切除术的麻醉体会。［方法］随机选取20例肺癌患者，手术胸腔镜进胸腔即单肺通气，潮气量８～10 mL/kg，频率14～16次／min，保持分钟通气量不变，并根据SpO₂、PETCO₂及时调整呼吸参数。病肺切除后充分吸引，恢复双肺通气。［结果］所有患者单肺通气30 min后SpO₂均>95%PETCO₂<45 mmHg,手术时间120~180 min，单肺通气60~120 min。［结论］掌握双腔支气管插管技术，加强单肺通气的术中管理，是胸腔镜下肺叶切除术得以顺利实施的关键。

Abstract:

［Objective］To summarize the anaesthesia experience of 20 cases of pulmonary lobectomy by VATS in the treatment of lung cancer.［Methods］Twenty patients of lung cancer were random selected. one-lung ventilation began as soon as the thoracoscope was put into thorax. The tidal volumn is 8~10 mL/kg, the frequence was 14~16 bit/min, and the minute ventilation was as same as that of double-lung ventilation. The respiratory parameters were adjusted by SpO₂,PETCO₂.When the sick lung was removed, double-lung ventilation was continued.［Results］All patients SpO₂were above 95%, PETCO₂below 45 mmHg, when one-lung ventilation had been held 30 minutes later. The time of operation was 120~180 minutes, and the time of one-lung ventilation was 60~120 minutes.［Conclusions］The technic of intubation of the double-lumen endobronchial tube, excellent management of one-lung ventilation, are the key factors for pulmonary lobectomy by VATS.