CAJ | 학술논문

目的评价单肺通气对泌尿外科腹膜后腔镜手术患者皮下气肿发生的影响.方法择期泌尿外科腹膜后腔镜手术患者27例,年龄29 ～ 64岁,体重指数19 ～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为2组:双肺通气组(Ⅰ组,n=15)和单肺通气组(Ⅱ组,n=12).Ⅰ组插入气管导管行双肺通气,Ⅱ组插入左侧双腔支气管导管行双肺通气,于气腹前10～ 15 min行非手术侧单肺通气至气腹结束后恢复双肺通气.于气腹前、气腹30 min、60 min及气腹结束后30 min时记录PETCO2、分钟通气量,计算CO2吸收量.气腹结束时记录皮下气肿的发生情况并评估皮下气肿程度.结果与Ⅰ组比较,Ⅱ组CO2吸收量减少,皮下气肿程度和皮下气肿发生率降低(P＜0.05).结论泌尿外科行腹膜后腔镜手术气腹期间,非手术侧单肺通气可减少CO2吸收量,降低皮下气肿的程度,减少皮下气肿的发生.
목적 평개단폐통기대비뇨외과복막후강경수술환자피하기종발생적영향.방법 택기비뇨외과복막후강경수술환자27례,년령29 ～ 64세,체중지수19 ～ 25 kg/m2,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장환자수궤분위2조:쌍폐통기조(Ⅰ조,n=15)화단폐통기조(Ⅱ조,n=12).Ⅰ조삽입기관도관행쌍폐통기,Ⅱ조삽입좌측쌍강지기관도관행쌍폐통기,우기복전10～ 15 min행비수술측단폐통기지기복결속후회복쌍폐통기.우기복전、기복30 min、60 min급기복결속후30 min시기록PETCO2、분종통기량,계산CO2흡수량.기복결속시기록피하기종적발생정황병평고피하기종정도.결과 여Ⅰ조비교,Ⅱ조CO2흡수량감소,피하기종정도화피하기종발생솔강저(P＜0.05).결론 비뇨외과행복막후강경수술기복기간,비수술측단폐통기가감소CO2흡수량,강저피하기종적정도,감소피하기종적발생.
Objective To investigate the effect of one-lung ventilation (OLV) on the occurrence of subcutanous emphysema during retroperitoneal laparoscopic urologic surgery (RPLUS).Methods Twenty-seven ASA Ⅰor Ⅱ patients,aged 29-64 yr,with body mass index 19-25 kg/m2,scheduled for elective RPLUS,were randomly divided into 2 groups:two-lung ventilation (TLV) group (group Ⅰ,n =15) and OLV group (group Ⅱ,n =12).In group Ⅰ,the patients were tracheal intubated and TLV was performed.In group Ⅱ,the left-sided double lumen endobronchial tube was inserted and TLV was performed,OLV on the non-operated side was performed starting from 10-15 min before pneumoperitoneum and TLV resumed at the end of pneumoperitoneum.The end-tidal CO2 partial pressure and minute ventilation volume were measured before pneumoperitoneum (T1),at 30 and 60 min of pneumoperitoneum (T2,3),and at 30 min after the end of pneumoperitoneum (T4).The CO2 absorption capacity was calculated.The degree of pneumoderma was assessed and the occurance of pneumoderma was recorded at the end of pneumoperitoneum.Results Compared with group Ⅰ,the CO2 absorption capacity was significantly reduced,and the degree and incidence of pneumoderma were significantly decreased in group Ⅱ (P ＜ 0.05).Conclusion OLV on the non-operated side can reduce the CO2 absorption capacity,decrease the degree of subcutaneous emphysema and reduce the occurrence of subcutanous emphysema during pneumoperitoneum in patients undergoing RPLUS.