The Research To The Degree Of Pulmonary Collapse Under The Bronchial Blocker In Esophageal Cancer Operation

Ojective: According to the Campos' method and the double lumen tube method,calculated the percentage of pulmonary collapse under the bronchial blocker in the esophageal operation to evaluate the pulmonary collapse and reduce the postoperative complications.Methods: Sixty patients of both sexes,with normal heart function and lung function,whose BMI was between 18.5 ~24 in ASA ?~?were 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 60 cases were divided into 3 groups(n=60)randomly: group A(n1=20),group B(n2=20)and group C(n3=20).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 given with penehyclidine hydrochloride 1mg and midazolam 0.05mg/kg 30 min before operation.The Electrocadiogram(ECG),Saturation of Pulse Oximetry(SpO2),Blood Pressure(BP),and Central Venous Pressure(CVP)were monitored with IntelliVue 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 5min,the trachea cannula of 7.5 ~8.0 was inserted into the trachea fixed by the same senior anesthesiologist.And the bronchial blockerwas inserted the left main bronchus.First check whether catheter counterpoint good by auscultation method.And then reoccupy fiberoptic bronchoscopy was used to determine the good counterpoint and check the airway conditions at the same time to ensure unobstructed and fixed.Controling respiration and monitoring patients with airway peak pressure(Ppeak),plateau airway pressure(Pplat).and end tidal carbon dioxide partial pressure(PETCO2)with DatexOhmeda 7100 ventilator.During operation we used intravenous-inhalational anesthesia with Remifentani(0.5~1?g/kg/min)and Sevoflurane(1~3%).We monitored Bispectral Index.The value was maintained between 40 and60.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 12times/min and Inspiration and Expiration ratio 1: 2.During one lung ventilation,the respiration parameters were setted:Tidal Volume6ml/kg,Respiratory Frequency 15times/min,Inspiration and Expiration ratio1:2.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 0.8,and ventilation frequency was 15 times/min.When the operation was performed to the anastomosis and the operation side pulmonary collapse completely,small tidal ventilation and injected gas were given to it to reach the degree of ? and ? of pulmonary collapse.And the volume of injected gas should be recorded.At the same time,pH value,arterial partial pressure of oxygen(PaO2),partial pressure of carbon dioxide arterial blood gas(PaCO2),Alveolar arterial oxygen difference(A-aDO2)were measured by Cabs b 123.And central venous pressure(CVP)and heart rate(HR)and pulse oxygen saturation(SpO2)were recorded.After two days,the number of cases of hoarseness,sore throat,and the number of cases of postoperative pulmonary infection occurs within 7 days were recorded.Results:1 There was no significant differences in three groups to age,gender,height,weight,PaO2 before anesthsia,FVC,FEV1/FVC(%),DLCO,the duration of surgery,hemoglobin,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 pH,partial pressure of arterial carbon dioxide(PaCO2),heart rate(HR),mean arterial pressure(MBP),and central venous pressure(CVP).(P>0.05)3 There was significant increase with respect to PaO2 and AaDO2(P<0.05)in group B and C compared with A.4 No significant differences were found in PaO2 and A-aDO2(P>0.05)in the two group B and C.5 The pulmonary collapse degree of three groups were 100%,80.2% and72.2%6 There were significant differences of three group at the degree of collapse(P<0.05)7There was no significant differences in three groups to hoarseness,sore throat,and the postoperative pulmonary infections(P>0.05)Conclusion:For patients undergoing thoractomy,low tidal volume ventilation to operation side can increase PaO2 and improve the patients' oxygenation.The pulmonary collapse degree of three groups were 100%~80.2%,80.2%~72.2% and 72.2%~0%.And the second degree does not disturb the operation and the patients' hemodynamics.Postoperative hoarseness,sore throat,and the incidence of complications such as pulmonary infection is lower than the double lumen.