Protective Effect Of Single-lumen Endotracheal Intubation And Continuous Carbon Dioxide Artificial Pneumothorax On The Lung Of Patients Undergoing Thoracoscopic Radical Esophagectomy

Background With the development of surgical endoscopy technology,radical resection of esophageal cancer under thoracic has become the most common surgical method in the treatment of esophageal cancer.During the operation,the anesthesia ventilation was mainly combined with double lumen tracheal intubation and single lumen tracheal intubation with carbon dioxide artificial pneumothorax ventilation,both of which could meet the need of operation.The traditional double-cavity endotracheal intubation is mainly used.It is not only complicated in intubation operation and high in technical requirements,but also relatively long in intubation time.Besides,it may extend the operation time and increase the airway damage due to wrong judgment of operation or left and right reversal.In addition,abnormal physiological changes caused by one-lung ventilation can increase the occurrence of pulmonary complications.The preferred ventilation mode is still controversial.Single lumen tracheal intubation with carbon dioxide artificial pneumothorax is a simple,convenient and less invasive ventilation mode.It can avoid single lung ventilation while satisfying the operation,reduce the incidence of lung ischemia-reperfusion injury and reduce the risk of lung injury.Reduce the incidence of postoperative pulmonary complications,shorten the hospitalization time,improve the quality of life of patients.Objective To investigate the protective effect of single-lumen endotracheal intubation and continuous carbon dioxide artificial pneumothorax on the lung of patients undergoing thoracoscopic radical esophagectomy.Methods A total of 60 patients who underwent thoracoscopic radical esophagectomy in the 989hospital of the joint logistic support force of the Chinese people’s liberation army from December 2016 to June 2017 were selected as the research subjects.The patients were divided into observation group（single-lumen endotracheal intubation and continuous carbon dioxide artificial pneumothorax）and control group（double-lumen tracheal intubation and single lung ventilation）by random digits table method,30 cases in each group.The patients in the observation group underwent single-lumen tracheal intubation and artificial pneumothorax by continuous injection of carbon dioxide gas and the double lung ventilation was continued during the operation.The patients in the control group were treated with double-lumen tracheal intubation,and the operating side lung ventilation was disconnected after tracheal intubation,and the non-operating side lung ventilation was performed during the operation,and the bilateral lung ventilation was restored after the thoracic operation,The internal jugular vein blood of the patients was collected at the time points of before tracheal intubation（T₀）,artificial pneumothorax establishment in the observation group or single lung ventilation in the control group for30 min（T₁）,artificial pneumothorax establishment in the observation group or single lung ventilation in the control group for 60 min（T₂）,30 min after artificial pneumothorax in the observation group or double lung ventilation in the control group（T₃）,and the end of the operation（T₄）.The levels of serum interleukin-4（IL-4）,IL-6,IL-8,IL-10 and tumor necrosis factor-α（TNF-α）were detected by enzyme linked immunosorbent assay（ELISA）.The pulse oxygen saturation（SpO₂）,arterial oxygen partial pressure（PaO₂）,arterial blood carbon dioxide pressure（PaCO₂）and airway pressure peak（Ppeak）of the patients in the two groups were recorded at the time points of T₀,T₁,T₂,T₃and T₄.The incidences of pulmonary complications within three days after operation were compared between the two groups.Results There was no significant difference in serum IL-4,IL-6,IL-8,IL-10 and TNF-αlevels between the two groups at T₀（P>0.05）.The levels of serum IL-4,IL-6,IL-8,IL-10 and TNF-αat T₁,T₂,T₃ and T₄ were significantly higher than those at T₀ in the two groups（P<0.05）.The levels of serum IL-6,IL-8 and TNF-αin the observation group were significantly lower than those in the control group at T₁,T₂,T₃ and T₄（P<0.05）;and the levels of serum IL-4 and IL-10 in the observation group were significantly higher than those in the control group at T₁,T₂,T₃ and T₄（P<0.05）.There was no significant difference in the SpO₂,PaO₂ and PaCO₂ between the two groups at T₀（P>0.05）.There was no significant difference in SpO₂ between the two groups at T₁,T₂,T₃ and T₄（P>0.05）.The PaO₂ and PaCO₂ in the observation group were significantly higher than those in the control group at T₁ and T₂（P<0.05）.There was no significant difference in PaO₂ and PaCO₂ between the two groups at T₃ and T₄（P>0.05）.The Ppeak in the observation group was significantly lower than that in the control group at T₁,T₂,T₃ and T₄（P<0.05）.There was no significant difference in operation time and intraoperative bleeding between the two groups（P>0.05）.With three days after operation,the incidence of complications in the control group and the observation group was 36.7%（11/30）and 16.7%（5/30）respectively the incidence of complications in the observation group was significantly lower than that in the control group（χ2=7.040,P<0.05）.Conclusion Compared with double-lumen tracheal intubation,single-lumen endotracheal intubation and continuous carbon dioxide artificial pneumothorax in thoracoscopic radical esophagectomy has less pulmonary injury and better pulmonary protection.