多索茶碱在食管癌根治术中的肺保护作用

目的探讨多索茶碱对食管癌根治术患者所致肺损伤的保护作用。方法选取择期全麻下行中下段食管癌根治术患者60例,男35例,女25例,年龄45~70岁,BMI 20~30kg/m~2,ASAⅠ或Ⅱ级,一秒用力呼气容积/用力肺活量(FEV_1%)50%。采用随机数字表法将患者分为两组:多索茶碱组(D组)和对照组(C组),每组30例。两组常规静脉诱导后,予以右侧双腔支气管插管后机械通气。D组于双腔支气管插管后静脉滴注多索茶碱4 mg/kg,30 min内滴注完毕,C组静脉滴注等量的生理盐水。在单肺通气(OLV)前10 min(T_0)、OLV后60 min(T_1)、双肺通气后(T_2)及手术结束(T_3)采集桡动脉血检测血清超氧化物歧化酶(SOD)活性和TNF-α、IL-6、IL-10、丙二醛(MDA)浓度,并检测各时点的血气。记录术中OLV时间、失血量、补液量和尿量,观察术后低氧血症、肺部炎症等不良反应的发生情况。结果与T_0时比较,T_1~T_3时两组血清SOD活性和PaO_2明显降低,TNF-α、IL-6、IL-10和MDA浓度均明显升高(P0.05)。与C组比较,T_1~T_3时D组血清SOD活性和PaO_2明显升高,TNF-α、IL-6、IL-10和MDA浓度明显降低(P0.05)。D组术后低氧血症和肺部炎症发生率明显低于C组(P0.05)。结论多索茶碱可抑制食管癌根治术患者OLV后的炎症反应和氧化应激反应,降低术后低氧血症、肺部炎症的发生率,减轻食管癌根治术引发的肺损伤。     

右美托咪定对食管癌根治术单肺通气患者血清炎性反应的影响

目的观察右美托咪定对食管癌根治术中单肺通气患者围术期血清炎性反应的影响。方法选取择期全麻下行食管癌根治术患者72例,男36例,女36例,年龄48~70岁,ASAⅠ或Ⅱ级,并用随机数字表法将患者均分为两组。D组于麻醉前静脉泵入右美托咪定0.5μg/kg,15min输注完后进行静脉诱导,随后按0.3μg·kg~(-1)·h~(-1)术中泵入,至手术结束前40min改为0.6μg/kg,泵入10min后停药。C组泵注等量生理盐水。两组静脉诱导完善后予左侧双腔支气管插管后机械通气,纤维支气管镜定位。在诱导前10min(T_0)、单肺通气后60min(T_1)、双肺通气30min(T_2)及术后120min(T_3)采集桡动脉血样检测血清TNF-α、IL-6、IL~(-1)0、巨噬细胞炎性蛋白-2(MIP-2)及人肺表面活性特异蛋白(SP-D)的水平。观察术中单肺通气时间、失血量、补液量、尿量及术后复苏室停留时间、呼吸机使用时间和苏醒期躁动、低氧血症、肺部炎症等不良反应的发生情况。结果与T_0时比较,T_1~T_3时两组血清TNF-α、IL-6、IL~(-1)0、MIP-2及SP-D浓度均明显升高(P0.05)。T_1~T_3时D组血清TNF-α、IL-6和SP-D浓度明显低于C组(P0.05),两组IL~(-1)0和MIP-2浓度差异无统计学意义。D组术后复苏室停留时间、呼吸机使用时间和苏醒期躁动、低氧血症、肺部炎症等不良反应的发生率明显低于C组(P0.05)。结论右美托咪定可通过抑制炎症反应减轻食管癌根治术单肺通气的围术期血清炎性反应,缩短复苏室停留时间、呼吸机使用时间和苏醒期躁动、低氧血症、肺部炎症等不良反应的发生率。     

丙泊酚或异氟醚麻醉对单肺通气时氧化应激反应的影响

目的 观察丙泊酚或异氟醚麻醉对单肺通气(OLV)时氧化应激反应的影响.方法 48例择期行食管癌根治术患者,随机分为丙泊酚单肺通气组(Pro-OLV组)、异氟醚单肺通气组(Iso-OLV组)、丙泊酚双肺通气组(Pro-TLV组)和异氟醚双肺通气组(Iso-TLV组),每组12例.于开胸前(T0)、OLV后(TLV组于开胸后)30 min(T1)、90 min(T2)、150 min(T3)、手术结束时(T4)测定血清超氧化物歧化酶(SOD)、丙二醛(MDA)及NO浓度.结果 与T0时比较,OLV组T1～T4时的SOD活性降低,MDA浓度及NO浓度升高(P<0.01),而TLV组无明显变化.与TLV组比较,OLV组T1～T4时的SOD活性降低,MDA及NO浓度升高(P<0.01).结论 丙泊酚或异氟醚麻醉均不能减轻OLV时氧化应激反应.     

不同压力持续气道正压对单肺通气氧化应激反应的影响

目的比较不同压力持续气道正压(CPAP)对单肺通气氧化应激反应的影响。方法择期行食管癌根治术患者48例,随机均分为双肺通气组(A组)、单肺通气组(B组)、单肺通气非通气肺给予2cmH2OCPAP组(C组)及5cmH2OCPAP组(D组)。分别于开胸前(T0)、单肺通气后(A组于开胸后)30min(T1)、90min(T2)、150min(T3)、手术结束(T4)时测定血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)、NO浓度。结果 T1～T4时B、C组及T2～T4时D组的SOD活性明显低于A组,T1～T4时B、C、D组MDA及NO浓度高于A组(P0.05)。T1～T4时C、D组MDA及NO浓度均显著低于B组(P0.05),T3时C、D组SOD活性显著高于B组(P0.05);T3时D组MDA及NO浓度高于C组(P0.05)。结论 CPAP能减轻单肺通气氧化应激反应,且2cmH2OCPAP优于5cmH2OCPAP。     

选择性肺叶隔离通气和单肺通气对患者肺内分流影响的比较

目的观察选择性肺叶隔离通气和单肺通气对胸科手术患者肺内分流的影响。方法择期行下段食管癌或贲门癌根治术患者60例,采用随机数字表法分为单肺通气组(OLV组)和选择性肺叶隔离通气组(SLC组)。OLV组患者采用支气管封堵器实施左肺隔离行右肺单肺通气;SLC组患者实施左下肺叶隔离行右肺+左上肺叶通气。于平卧位双肺通气10分钟(T_0)、侧卧位双肺通气后10分钟(T_1)、单肺通气或选择性肺叶隔离通气10分钟(T_2)和术毕双肺通气10分钟(T_3)4个时点取桡动脉血和中心静脉血,进行血气分析,计算肺内分流率(Qs/Qt)。结果与T_0时比较,两组患者在T_1、T_2、T_3时的Pa O_2均明显降低(P0.05),SLC组T_2时Pa O_2明显高于OLV组(t=-7.376,P=0.000);与T_0时比较,两组患者在T_1、T_2、T_3时的Qs/Qt均明显升高,SLC组在T_2、T_3时Qs/Qt均明显低于OLV组(t=8.766,P=0.000;t=2.375,P=0.000)。结论选择性肺叶隔离通气适用于下段食管癌或贲门癌根治术的通气管理,能明显减少单肺通气时的肺内分流,提高单肺通气时氧分压。     

硫酸镁预处理对单肺通气所致缺血再灌注肺损伤的影响

目的观察硫酸镁预处理对单肺通气缺血再灌注所致肺损伤的保护作用。方法择期在胸腔镜下行肺叶切除术患者80名,随机分为硫酸镁组(M组,n=40)和对照组(C组,n=40)。硫酸镁组给予硫酸镁静脉输注,对照组给予等量生理盐水。分别于麻醉诱导前1分钟(T_0)、单肺通气前1分钟(T_1)、单肺通气结束前1分钟(T_2)、双肺通气30分钟(T_3)时测定血清丙二醛(MDA)的浓度;从患侧肺叶取小块正常肺组织,测定该肺组织血红素氧合酶(HO-1)的含量;术后2h抽取桡动脉血1ml作血气分析,计算氧合指数。结果 T_3时刻血清MDA浓度M组低于C组(P0.05),术侧肺叶组织HO-1浓度M组高于C组(P0.05),术后2小时时肺氧合指数M组高于C组(P0.05)。结论硫酸镁预处理对单肺通气患者的缺血再灌注损伤具有保护作用,其机制可能与上调肺组织HO-1的表达水平,抑制细胞脂质过氧化反应有关。     

依达拉奉对单肺通气患者肺组织氧化应激反应的影响

目的 评价依达拉奉对单肺通气患者肺组织氧化应激反应的影响.方法 择期拟行食管癌根治术患者30例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄40～64岁,体重50～85 kg,采用随机数字表法,将其随机分为2组(n=15).依达拉奉组(E组)气管插管后即刻,以60.0 mg/h速率静脉输注依达拉奉30min,随后以7.5 mg/h速率输注至术毕.对照组(C组)给予等容量生理盐水.分别于切皮前即刻、单肺通气30 min、双肺通气30 min时采集动脉血样和静脉血样,进行动脉血气分析,计算氧合指数、肺泡-动脉血氧分压差以及呼吸指数,并测定静脉血血清丙二醛(MDA)和8-异前列腺素F2a的浓度.结果 与C组比较,E组双肺通气30 min时肺泡-动脉血氧分压差、呼吸指数、血清MDA和8-异前列腺素F2a浓度降低(P＜0.05),氧合指数差异无统计学意义(P＞0.05).结论 依达拉奉减轻单肺通气患者肺损伤的机制与抑制肺组织氧化应激反应有关.     

食管癌手术患者单肺通气时血清炎性细胞因子与氧自由基的检测及意义

目的 探讨食管癌手术患者单肺通气(OLV)时血清炎性细胞因子与氧自由基的检测及其意义.方法 拟行食管癌手术患者36例,分别在麻醉诱导后OLV前(T1)、OLV 45min(T2)、90min(T3)及双肺通气后30min(T4)采取外周静脉血,分别测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-8、丙二醛(MDA)的浓度及超氧化物歧化酶(SOD)活性.结果 与T1时比较,T2时患者血清TNF-α、IL-6、IL-8水平和MDA浓度均明显上升(P<0.05),SOD活性显著降低(P<0.05);与T3时比较,T4时患者血清TNF-α、IL-6、IL-8水平和MDA浓度均明显降低(P<0.05),SOD活性显著升高(P<0.05).结论 单肺通气期间血清中炎性细胞因子的释放和氧自由基的生成显著增加,提示引起急性肺损伤.     

甲基强的松龙对肺叶切除术患者单肺通气时肺功能和炎症反应的影响

目的探讨甲基强的松龙(甲强龙)对肺叶切除术患者单肺通气时肺功能和炎症反应的影响。方法选择择期拟行肺叶切除术患者60例,男46例,女14例,年龄18~60岁,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:甲强龙组(M组)和对照组(C组),每组30例。M组于麻醉诱导前30min静脉注射甲强龙2mg/kg,C组于相同时点静脉注射等量生理盐水。分别记录单肺通气前(T_0)、单肺通气30min(T_1)、单肺通气1h(T_2)、恢复双肺通气10min(T_3)及术毕(T_4)时的MAP、气道峰压(Ppeak)、气道平台压(Pplat)及动态肺顺应性(Cdyn),并于上述时间点抽取桡动脉血行血气分析,检测PaO_2和PaCO_2,计算氧合指数(OI)、肺泡-动脉血氧分压差(A-aDO_2)及呼吸指数(RI)。分别于T_0、T_4、术后6h(T_5)及术后24h(T_6)采集中心静脉血样,采用ELISA法检测血清TNF-α、IL-6及IL-10的浓度。记录术后72h肺部并发症的发生情况。结果与T_0时比较,T_1、T_2时两组MAP、Cdyn明显降低,Ppeak、Pplat明显升高(P0.05);T_1~T_4时OI明显降低,A-aO_2、RI明显升高(P0.05);T_4~T_6时血清TNF-α、IL-6及IL-10浓度明显升高(P0.05)。与C组比较,T_1、T_2时M组Ppeak、Pplat明显降低,Cdyn明显升高(P0.05);T_4~T_6时M组血清TNF-α、IL-6浓度明显降低,IL-10浓度明显升高(P0.05)。两组患者术后72h肺部并发症发生率差异无统计学意义。结论甲强龙可有效改善肺叶切除术患者单肺通气时动态肺顺应性,优化呼吸动力学,减轻机体炎症反应,但对肺氧合及换气功能无明显影响。     

肺保护性通气策略联合右美托咪定对胸腔镜肺癌根治术患者的肺保护作用

目的观察肺保护性通气策略联合右美托咪定对胸腔镜肺癌根治术患者炎症反应及术后肺部并发症的影响。方法选择择期行胸腔镜肺癌根治术的患者40例,男23例,女17例,年龄40～64岁,BMI 20～25 kg/m~2,ASAⅠ或Ⅱ级,随机分为两组:肺保护性通气策略组(P组)和肺保护性通气策略联合右美托咪定组(DP组)。DP组于麻醉诱导前10 min静脉泵注右美托咪定负荷量0.5μg/kg(10 min泵注完毕),随后以0.6μg·kg~(-1)·h~(-1)持续泵注至手术结束;P组以等容量生理盐水持续静脉泵注。双肺通气及单肺通气期间所有患者均采用相同的通气策略:V_T 6 ml/kg,FiO_2 70%,PEEP 5cmH_2O。分别在麻醉诱导前(T_0)、单肺通气前即刻(T_1)、单肺通气1 h(T_2)、单肺通气2 h(T_3)、术后2 h(T_4)、术后24 h(T_5)检测血清TNF-α、IL-6和MPO含量;记录术后肺部并发症情况。结果与P组比较,T_2—T_5时DP组TNF-α、IL-6、MPO含量明显降低(P0.05)。P组有2例(10%)肺部并发症。结论肺保护性通气策略联合右美托咪定用于胸腔镜肺癌根治术能够进一步减轻术中炎症反应,可能有助于减少术后肺部并发症的发生。     

帕瑞昔布钠对食管癌根治术患者单肺通气时肺内分流的影响

目的 探讨帕瑞昔布钠对食管癌根治术患者单肺通气(OLV)时肺内分流的影响.方法 择期行食道癌根治术患者45例,年龄47～57岁,体重42～59kg,ASA分级Ⅰ或Ⅱ级,随机分为2组:生理盐水组(C组,n=23)和帕瑞昔布钠组(P组,n=22).P组静脉注射帕瑞昔布钠40 mg(生理盐水稀释至10 ml),C组静脉注射等容量生理盐水.随后两组均靶控输注异丙酚(效应室靶浓度4μg/m1)和舒芬太尼(效应室靶浓度0.3 ng/ml)行麻醉诱导,静脉注射罗库溴铵0.9 mg/kg,光纤支气管镜引导下插入双腔气管导管,行机械通气.于麻醉诱导开始后30 min(T0)、单肺通气15 min(T1)、30 min(T2)、1 h(T3)、恢复双肺通气30 min(T4)和1 h(T5)时测定CVP、HR、MAP和气道平均压(Pmean),同时采集颈内静脉和桡动脉血样,进行血气分析,计算肺内分流率(Qs/Qt).结果 与T0时比较,两组T1-3时Pmean 和Qs/Qt升高(P＜0.05);与T1时比较,两组T2.3.时Qs/Qt降低(P＜0.05);两组各时点Pmean、Qs/Qt、CVP、HR和MAP比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠40 mg对食管癌根治术患者单肺通气时缺氧性肺血管收缩反应无影响.     

The effects of oxidative stress on the liver and ileum in rats caused by one-lung ventilation

BACKGROUND AND AIM: Reactive oxygen radicals that cause remote organ injury are increased after the one-lung ventilation frequently used in thoracic surgery. The aim of this study was to examine the effects of one-lung ventilation on the liver and ileum. MATERIALS AND METHODS: Thirty rats were divided into five groups: a sham group; 3- and 4-h mechanical ventilation groups; and 1- and 2-h left lung collapse/2-h re-expansion groups (n = 6 for each group). In the collapse groups, the left lung was collapsed by bronchial occlusion for 1 and 2 h and then re-expanded and ventilated for an additional 2 h. At the end of the study, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were determined to assess liver functions. Myeloperoxidase (MPO) and malondialdehyde (MDA) activity were determined in the liver and ileum tissues. The tissues were also examined by light and electron microscope. Apoptosis was assessed using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) assay. RESULTS: Plasma ALT and AST, tissue MDA, and MPO activities in both tissues were significantly higher in the 2-h collapse/2-h re-expansion group than in the 4-h mechanical ventilation group (P < 0.05). Moreover, the levels were significantly higher in the 2-h collapse group compared to the 1-h collapse group (P < 0.016). Tissue damage and apoptotic index were most prominent in the 2-h collapse/2-h re-expansion group. CONCLUSION: Our findings showed that one-lung ventilation causes tissue damage in the liver and ileum and that this damage increases as occlusion duration rises.     

依达拉奉预先给药对单肺通气患者肺损伤的影响

目的 探讨依达拉奉预先给药对单肺通气患者肺损伤的影响.方法 择期行食管下段癌切除术患者40例,男性,ASA分级Ⅰ或Ⅱ级,年龄48～64岁,体重指数18～26 kg/m2,随机分为2组(n=20):对照组(C组)和依达拉奉组(E组).E组于切皮时开始静脉输注依达拉奉0.5 mg/kg(溶于100 ml生理盐水),经30 min输注完毕.术中记录PETCO2和气道压峰值(Ppeak).于开胸前和术毕时取肘静脉血样,检测血清肺表面活性蛋白A(SP-A)、MDA、SOD和TNF-α的水平.结果 两组术中PETCO2、Ppeak比较差异无统计学意义(P＞0.05).两组单肺通气后血清SOD活性降低,MDA、TNF-α、SP-A水平升高(P＜0.05);与C组比较,E组血清SOD活性升高,MDA、TNF-α、SP-A水平降低(P＜0.05).结论 依达拉奉预先给药可抑制氧化应激反应和炎性反应,减轻单肺通气患者的肺损伤.     

Effect of re-expansion after short-period lung collapse on pulmonary capillary permeability and pro-inflammatory cytokine gene expression in isolated rabbit lungs

Background. Re-expansion pulmonary oedema is a rare complicationcaused by rapid re-expansion of a chronically collapsed lung.Several cases of pulmonary oedema associated with one-lung ventilation(OLV) have been reported recently. Elevated levels of pro-inflammatorycytokines in pulmonary oedema fluid are suggested to play importantroles in its development. Activation of cytokines after re-expansionof collapsed lung during OLV has not been thoroughly investigated.Here we investigated the effects of re-expansion of the collapsedlung on pulmonary oedema formation and pro-inflammatory cytokineexpression. Methods. Lungs isolated from female white Japanese rabbits wereperfused and divided into a basal (BAS) group (n=7, baselinemeasurement alone), a control (CONT) group (n=9, ventilatedwithout lung collapse for 120 min) and an atelectasis (ATEL)group (n=9, lung collapsed for 55 min followed by re-expansionand ventilation for 65 min). Pulmonary vascular resistance (PVR)and the coefficient of filtration (Kfc) were measured at baselineand 60 and 120 min. At the end of perfusion, bronchoalveolarlavage fluid/plasma protein ratio (B/P), wet/dry lung weightratio (W/D) and mRNA expressions of tumour necrosis factor (TNF)-     

氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响

目的 评价氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响.方法 选择开胸手术患者45例,年龄37～64岁,体重53～65 kg,ASAⅠ或Ⅱ级,随机分为3组(n=15),双肺通气组(TLV组)、单肺通气组(OLV组),单肺通气+氨溴索组(OLV+AMB组)于单肺通气前25 min开始静脉输注氨溴索1 mg/kg(100 ml,4 ml/min),TLV组和OLV组静脉输注等容量生理盐水.OLV组和OLV+AMB组于麻醉诱导前(T0)、单肺通气前即刻(T1)、单肺通气0.5 h(T2)、1 h(T3)、2 h(T4)、恢复双肺通气后1 h(T5)、2 h(T6)和术后24 h(T7)时,TLV组于上述对应时点,采集桡动脉血样,测定血清TNF-α、IL-6、IL-8浓度和SOD活性,进行WBC和中性粒细胞(PMN)计数.结果 与TLV组比较,OLV组血清IL-6、IL-8、TNF-α浓度升高,SOD活性降低,WBC和PMN计数升高(P<0.05或0.01);与OLV组比较,OLV+AMB组血清IL-6、IL-8和TNF-α浓度降低,SOD活性升高,WBC和PMN计数降低(P<0.05或0.01).结论 氨溴索1 mg/kg预先给药可减轻单肺通气患者炎性反应及脂质过氧化反应.     

Oxygenation during one-lung ventilation: the effects of inhaled nitric oxide and increasing levels of inspired fraction of oxygen

We studied whether inhaled nitric oxide (NO) would improve arterial oxygen tension (PaO(2)) and reduce the occurrence of oxygen saturation of hemoglobin (O(2)Hb) < 90% during one-lung ventilation (OLV). One-hundred-fifty-two patients were ventilated either with or without NO (20 ppm) with an inspired fraction of oxygen (FIO(2)) of either 0.3, 0.5, or 1.0 during OLV. Anesthesia was induced and maintained with propofol, remifentanil, and rocuronium IV, and lung separation was achieved with a double-lumen tube. During OLV, we set positive end-expiratory pressure at 5 cm H(2)O, peak pressure at 30 cm H(2)O, and end-tidal CO(2) at 30 mm Hg. The nonventilated lung was opened to room air and collapsed. During OLV, three consecutive measurements were performed every 10 min. The operated lung was temporarily ventilated if pulse oximetric saturation (SpO(2)) decreased to < 91%. SpO(2) <9 1% occurred in 2 of the 152 patients. SpO(2) overestimated O(2)Hb by 2.9% +/- 0.1%. NO failed to improve oxygenation or alter occurrence of O(2)Hb < 90% during OLV across all time points and all levels of FIO(2). Increasing FIO(2) increased oxygenation and decreased occurrence of O(2)Hb < 90% (P: < 0.001). At FIO(2) = 1, PaO(2) was higher (P < 0.01) and O(2)Hb < 90% rate tended to be lower (P = 0.1) during right versus left lung ventilation. PaO(2) was higher in patients undergoing pneumonectomy and lobectomy than in those undergoing metastasectomy or video-assisted operations (P < 0.05). IMPLICATIONS: Inhaled nitric oxide failed to improve oxygenation during one-lung ventilation. Oxygenation during one-lung ventilation was improved with increasing levels of FIO(2) during ventilation of the right versus the left lung and with increasing pathology of the nonventilated lung.     

Coopdech支气管堵塞导管行左下肺叶隔离的可行性

目的 观察Coopdeeh支气管堵塞导管对肺功能正常的下段食管癌根治术患者作左下肺叶隔离的可行性,以及对患者肺顺应性、吸气峰压和氧合作用的影响.方法 拟行左侧剖胸下段食管癌根治术患者30例,ASAⅠ～Ⅱ级,按随机数字表法,随机分成支气管堵塞导管组(BB组)和左双腔支气管导管(double-lumen endobronchial tube,DLT)组(DLT组),每组15例.丙泊酚靶控输注静脉诱导后.BB组插入8# 单腔气管导管,纤维支气管镜引导9 Fr Coopdech支气管堵塞导管置入左下肺叶支气管,DLT组插入左DLT,2组均作双肺间歇正压通气.20 min后摆放右侧卧位,DLT组行右单肺通气,BB组对堵塞导管套囊充气行右肺和左上肺叶通气.20 min后手术开始,全程采用丙泊酚靶控输注维持麻醉,间歇追加舒芬太尼和顺阿曲库铵.于双肺通气后20 min(T_1),右单肺通气或右肺和左上肺叶通气后20 min(T_2),开胸见左肺或左下肺叶完全萎陷后(T_3),术毕拔出气管导管前(T_4)行动脉血气分析,记录肺顺应性和吸气峰压,并请手术医生在开胸后即刻评价术野清晰度.观察期间,机械通气参数不变.术后第1天作动脉血气分析和胸片检查.结果 2组患者的术野评价,各时点pH、动脉二氧化碳分压,T_1的动脉氧分压、吸气峰压和肺顺应性差异无统计学意义.在T_2～T_4时点,BB组的PaO_2分别为(220±56)mmHg、(188±57)mg Hg、(208±24)mm Hg,高于DLT组(146±38)mm Hg、(140±36)mm Hg、(157±33)mm Hg;肺顺应性分别为(36±9)ml/cm H_2O,高于DLT组(24±6)ml/cm H_2O,(35±12)ml/cm H_2O,BB组的吸气峰压分别为(17.7±2.9)cm H_2O、(17.8±3.2)cm H_2O、(14.82.2)cm H_2O,低于DLT组的(21.7±3.6)cm H_2O、(22.6±2.6)cm H_2O,(16.8±1.8)cm H_2O(P<0.05).BB组术后无肺不张病例,DLT组有1例发生左下肺不张.结论 支气管堵塞导管行左下肺叶隔离能在左侧剖胸下段食管癌根治术中提供清晰的术野,并能降低患者的吸气峰压,改善肺顺应性、增加氧合.