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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(T_0)和人工气胸后5min(T_1)、10min(T_2)、30min(T_3)的HR、MAP、SpO_2、PETCO_2、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、PaO_2、PaCO_2;评估两组患儿人工气胸后5min(T_1)、10min(T_2)的肺萎陷和手术野情况。结果 T_1-T_2时B组患儿SpO_2、PaO_2、肺萎陷和手术野评分均明显高于A组(P<0.05)。T_3时两组患儿SpO_2和PaO_2差异无统计学意义。T_0-T_3时两组患儿HR、MAP、PETCO_2、RR、Pinsp、PEEP、动脉血pH值、PaCO_2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 explore the effect of single lung ventilation in neonatal thoracoscopic surgery. Methods Sixty children with congenital esophageal atresia who underwent thoracoscopic esophagectomy underwent esophageal atresia ASA class Ⅱ or Ⅲ, 31 males and 29 females, and were born 1-28 days. Randomly divided into endotracheal intubation group (A group) and endotracheal intubation group (B group). After induction of anesthesia, children in group A underwent endotracheal intubation under laryngoscope visualization. Children in group B underwent endotracheal intubation of general endotracheal tubes under the guidance of microfibersional bronchoscopy (Φ2.4mm), in which left Aortic arch who left main bronchial catheterization, on the contrary, the right aortic arch right main bronchial catheterization, and in the lateral position and then check again to confirm the endotracheal tube position. HR, MAP, SpO2, PETCO2, RR, Pinsp and PEEP were recorded at 5 min (T 0) and 5 min (T 1), 10 min (T 2) and 30 min The arterial blood pH value, PaO_2 and PaCO_2 were measured at the arterial blood gas analysis at the time points. The conditions of lung collapse and operation at 5 min (T_1) and 10 min (T_2) after the artificial pneumothorax were evaluated. Results The scores of SpO 2, PaO 2, pulmonary collapse and operative field in group B at T 1 -T 2 were significantly higher than those at group A (P <0.05). T_3 two groups of children SpO_2 and PaO_2 difference was not statistically significant. T_0-T_3 in two groups of children HR, MAP, PETCO_2, RR, Pinsp, PEEP, arterial blood pH, PaCO_2 differences were not statistically significant. Conclusion Single lung ventilation for neonatal thoracoscopic surgery is not only safe and feasible, but also can effectively improve oxygenation and improve lung collapse and surgical field exposure.