电视胸腔镜下行肺大泡手术的麻醉管理

目的探讨电视胸腔镜下肺大泡手术的麻醉管理方法。方法总结和分析10例择期电视胸腔镜下肺大泡手术的麻醉、监测和单肺通气管理的情况。结果本组病例全部采用静吸复合全麻,麻醉平稳,双腔气管导管插管顺利,左右肺分隔满意。麻醉期间血流动力指标稳定。手术时间100~240min〔平均(162±46)min〕,单肺通气时间60~200min〔平均(102±42)min〕,超过2h有3例,超过3h者1例。单肺通气期间绝大多数患者SpO2维持在98%~100%。术毕均顺利苏醒拔管,无苏醒延迟、复张性肺水肿及其他麻醉并发症。结论电视胸腔镜下肺大泡手术的麻醉管理应着重强调麻醉平稳、防治张力性气胸、正确定位双腔气管导管、加强单肺通气的呼吸管理和防治低氧血症。

Anesthetic management of lung bullae surgery with video-assisted thoracoscopy

Objective To explore the anesthetic management of patient undergoing lung bullae surgery with video-assisted thoracoscopy.Methods Anesthesia of 10 patients undergoing lung bullae surgery with video-assisted thoracoscopy were summarized and analyzed.The specific problems associated with anaesthesia in patients with bullae,such as precautionary measures of acute enlargement or rupture of the bullae and management of one-lung ventilation,were discussed.Results The patients were between 17 years and 47 years of age.Anesthesia was induced and maintained using the combination of intravenous and inhalational anesthesia.A double-lumen endobronchial tube(DLT) was used to separate the lungs,and one-lung ventilation(OLV) was administered to facilitate thoracoscopic procedure.The mean operation time was 162min(range from 100 to 240 min),and the average time of OLV was 102 min(range from 60 to 200 min).The hemodynamics parameters and pulse oxymetry oxygen saturation(SpO_2) remained stable in the period of OLV.The delay recovery from anesthesia was not observed in all patients.There was no reexpansion pulmonary edema and other anesthetic complication.Conclusion The key points of anesthetic management for lung bullae surgery with video-assisted thoracoscopy were stable anesthesia,correct position of DLT,ventilation management of OLV,prevention and treatment of tension pneumothorax and hypoxemia.