The Research To The Degree Of Pulmonary Collapse Of Operation Side In Esophageal Cancer Operation

Ojective: According to Campos’ method,calculated the percentage of pulmonary collapse in the esophageal operation to evaluate the pulmonary collapse and reduce the postoperative complications.Methods:Ninety patients of both sexes,with normal heart function and lung function,whose BMI was between 18.5 ~24 in ASA Ⅰ~Ⅱwere scheduled for thoracic surgery.The patients did not have anemir and other diseases of blood system,did not have chemotherapy and radiotherapy.The patients with left thoracotomy were operated by the same doctor.The 90 cases were divided into 3 groups(n=20)randomly: group A (n1=30), group B(n2=30) and group C(n3=30).The pulmonary function test was routine preoperative test.And then record the total lung capacity.After entering operation room,the upper limb venous access was founded,then the petients were givenwith penehyclidine hydrochloride 1mg and midazolam 0.05mg/kg 30 min before operation.The Electrocadiogram(ECG), Saturation of Pulse Oximetry(Sp O2), Blood Pressure(BP), and Central Venous Pressure(CVP)were monitored with Intelli Vue MP50 multifunctional monitor.Anesthesia induction:intravenous injection with Fentanyl(2-4ug/kg),Etomidate(0.2-0.3mg/kg),and as their consciousness disappearing,Cisatracurium(0.3mg/kg) was needed.After 3min, the right double lumen endobronchial tube inserted was inserted into the trachea by the same senior anesthesiologist.And then fiberoptic bronchoscopy was essential. Controling respiration and monitoring patients with airway peak pressure (Ppeak), plateau airway pressure(Pplat).and end tidal carbon dioxide partial pressure(PETCO2) with Datex-Ohmeda 7100 ventilator.During operation we used intravenous-inhalational anesthesia with Remifentani( 0.5~1μg/kg/min) and Sevoflurane(1~3%).We monitored Bispectral Index.The value was maintained between 40 and 60.Cisatracurium(0.05mg/kg) was given every half an hour to ensure muscle enlaxation.The basic respiratory parameters:oxygenflow was 1L/min and oxygen concentration was 80%. During two lung ventilation,respiratory parammeters was setted:Tidal Volume 8ml/kg,Respiratory Frequency 12 times/min and Inspiration and Expiration ratio 1 : 2.During one lung ventilation,the respiration parameters were setted:Tidal Volume 6ml/kg,Respiratory Frequency 15~17 times/min,Inspiration and Expiration ratio 1:2.In group A,the bronchial tube of operation side lung was exposed to the air directly.In the guoup B and group C,The bronchial tube of operation side lung was connected with breathing bag with a tidal volume meter(we can see it in the figure behind).The respiration parameters of operation side :Fresh gas flow was 1L/min,oxygen concentration was 0.73,and ventilation frequency was 15 times/min.When the operationwas performed to the anastomosis and the operation side pulmonary collapse completely,small tidal ventilation was given to it to reached the degree of Ⅱ and Ⅲ of pulmonary collapse.And the tidal volume should be recorded.At the same time,p H value, arterial partial pressure of oxygen(Pa O2), partial pressure of carbon dioxide arterial blood gas(Pa CO2), Alveolar arterial oxygen difference(A-a DO2)were measured by Cabs b 123. And central venous pressure(CVP) and heart rate(HR) and pulse oxygen saturation(Sp O2)were recorded.Results:1 There was no significant differences in three groups to age, gender,height,weight,hemoglobin,Pa O2 before anesthsia,FVC, FEV1/FVC(%), DLCO,the duration of surgery,the duration of OLV(one lung ventilation),fluid volume and urine volume(P>0.05)2 Compared with the group A,the blood gas analysis of group B and group C was not statistically different.Included the valve of p H, partial pressure of arterial carbon dioxide(Pa CO2),alveolar arterial oxygen tension difference(A-a DO2), heart rate(HR), mean arterial pressure(MBP), and central venous pressure(CVP).(P>0.05)3 There was significant increase with respect to Pa O2(P<0.05) in group B and group C compared with group A.4 No significant differences were found in p H,Pao2,Pa CO2,,HR,Mean Blood Pressure(MBP),Central Venous Pressure(CVP)(P>0.05)in the two group B and C.5 Compared with group C,A-a DO2 was significantly decreased than group B(P<0.05)6 The pulmonary collapse degree of three groups were 100%,74% and 59%7 There were significant differences of three group at the degree of collapse(P<0.05)Conclusion:For patients undergoing thoractomy,low tidal volume ventilation to operation side can increase Pa O2 and improve the patients’ oxygenation. The pulmonary collapse degree of three groups were 100%~74%,74%~59% and 59%~0%.And the second degree does not disturb the operation and the patients’ hemodynamics.