Objective To evaluate the effectiveness of thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) versus GA alone on intrapulmonary shunting during one-lung ventilation (OLV). Methods We searched the Cochrane Library (Issue 4, 2009), the specialized trials registered in the Cochrane anesthesia group, PubMed (1966 to Dec. 2009), EMbase (1966 to Dec. 2008), CBM (1978 to Dec. 2009), VIP (1989 to Dec. 2009), CNKI (1915 to Dec. 2009), and handsearched Clinical Anesthesia Journal and Chinese Anesthesia Journal. Randomized controlled trials (RCTs) about the effectiveness of TEA combined with GA versus GA alone on intrapulmonary shunting during OLV were included, The methodological quality of included RCTs was evaluated by two reviewers independently, Meta-analysis was conducted using RevMan 5.0 software. Results Ten RCTs involving 506 patients were included. The results of meta-analyses showed that there were no significant differences in intrapulmonary shunting during OLV at different times-points of 5, 15, 20, 30, and 60 minutes after OLV. Conclusion Both TEA combined with GA and GA alone have the same Security during OLV. But owing to the low quality and small sample size of the included studies, further more well-designed, large sample size RCTs are needed.
【摘要】 目的 研究肺癌患者的气道高反应性和肺通气功能情况，并探讨其易感因素，为肺癌患者肺通气功能的临床评估提供依据。 方法 对2010年4月-2011年4月收治的40例肺癌患者（A组）进行术前肺功能检测及气管激发试验，选取同期的健康体检者40例做对照组（B组），并采用logistic逐步回归分析肺癌患者的气道高反应性的易感因素。 结果 ①A组患者的用力肺活量、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、最高呼气流量（peak expiratory flow，PEF）以及最大呼气中期流量均小于B组，且差异有统计学意义（P=0.000）；②A组的FEV1估计异常人数和PEF估计异常人数均多于B组（Plt;0.05）；③A组组胺气道激发试验阳性者多于B组（χ2=5.000，P=0.025），且A组PD20FEV1低于对照组[分别为（4.69±0.82）、（8.32±1.43）μmol/L；t=13.930，P=0.000]；④logistic逐步回归分析表明影响A组患者的气道高反应性的因素为年龄、分型、TNM分期、病史、吸烟。 结论 肺癌气道反应性增高，且肺功能下降，由于肺癌气道高反应性的易感因素较多，因此需对合并因素较多者进行及时的预防，防止由于气道阻力增加和气道狭窄引起的胸闷、咳嗽、喘息和呼吸困难等症状。【Abstract】 Objective To learn the condition of bronchial hyper-reactivity and pulmonary function in patients with lung cancer, and explore the risk factors for bronchial hyper-reactivity in order to provide clinical reference for pulmonary function evaluation in patients with lung cancer. Methods Forty patients with lung cancer treated in our hospital from April 2010 to April 2011 (research group) took pulmonary function and tracheal stimulation tests before operation, and in the meanwhile, 40 healthy people were chosen as controls. The logistic regression analysis was employed to analyze the risk factors for bronchial hyper-reactivity. Results The forced vital capacity, forced expiratory volume in one second (FEVl), peak expiratory flow (PEF) and maximal mid expiratory flow in the research group patients were all significantly lower than those in the control group patients (P=0.000). The number of patients with estimated FEVl and PEF abnormality in the research group was more than that in the control group (P=0.05). The number of patients positive in histamine bronchial provocation test in the research group was more than that in the control group (χ2=5.000, P=0.025), and the PD20FEV1 level of the research group was lower than that of the control group [(4.69±0.82) and (8.32±1.43) μmol/L; t=13.930, P=0.000]. Logistic regression analysis showed that the risk factors for bronchial hyper-reactivity in patients with lung cancer were age, type, TNM stage, history of lung cancer, and smoking. Conclusions The airway reactivity elevates and the lung cancer pulmonary function decreases in lung cancer patients. Because there are many risk factors, prevention should be taken for patients with combined risk factors to avoid the occurrence of chest distress, cough, gasp and dyspnea caused by increased airway resistance and stricture.
Objective To study the effects of hemodilution on oxygenation during one-lung ventilation(OLV).Methods Forty patients undergoing lung surgery with or without chronic obstructive pulmonary disease（COPD）were enrolled.The study was performed in the supine position before surgery.The tracheas were intubated with a double-lumen tube.OLV was initiated for 15 min.After 15 min of OLV，arterial and venous blood gas samples were collected and analyzed.The cardiac output (CO) was measured.Two-lung ventilation was reinstituted，and hemodilution was performed (6% hydroxyethyl starch，10 mL/kg).Subsequently，OLV was performed again for 15 min.Then arterial and venous blood gas samples were collected and analyzed.The cardiac output (CO) was measured.Results Hemodilution resulted in a significant and similar decrease in HB concentration in patients both with or without COPD.However，hemodilution resulted in a significant decrease in PaO2 in COPD patients rather than subjects without COPD.Conclusion Mild hemodilution impairs gas exchange during OLV in COPD patients.
单肺通气技术( OLV) 广泛应用于开胸手术, 该技术使手术侧肺萎陷, 非手术侧单肺通气, 目的是防止手术侧肺分泌物或血液流入健侧肺, 确保气道通畅, 防止交叉感染, 避免手术侧肺膨胀, 使肺保持安静以利于手术操作, 减轻对肺实质的损伤。随着手术日益走向微创时代, 对该技术的需求大量增加。
Objective To assess the value of pulmonary ventilation test in evaluating the prognosis of cardiac surgery patients. Methods Data were collected retrospectively from consecutive patients with coronary heart disease or valvular disease, who were prepared for cardiac surgery in Zhongshan Hospital from January 2007 to December 2008. The main outcome indices were mortality of surgery, the prolonging time of using artificial airway ( ≥3 days) , and the prolonging time in intensive care units ( ICU) ( ≥5 days) . Then the relationship between the poor outcome and ventilation disorder was analyzed. Results In the 422 cases,the incidence of ventilation disorder was 55% , included 27. 5% restrictive ventilation disorder, 15. 6% obstructive ventilation disorder, and 11. 8% mixed ventilation disorder. And the severity of pulmonaryventilation disorder was mild of 34. 6% , moderate of 15. 2% , and severe of 5. 2% . Among the 42 patients who gave up surgery,50% were due to ventilation dysfunction, and the patients were prone to give up surgery with the deterioration of pulmonary function( P lt; 0. 001) . But comparing with the patients with normal pulmonary function, the risk of poor outcome after surgery did not significantly increase in the patients with ventilation disorder ( P gt; 0. 05 ) . The logistic regression analysis indicated that cardiopulmonary bypass ( CPB) was an absolute risk factor ( P lt; 0. 05) . Conclusions The incidence of ventilation disorder in patients with cardiac disease is quite high. Severe pulmonary ventilation disorder is the significant cause of giving up surgery, but may be not the absolute contraindication of cardiac surgery.
Objective To study the protective effects and mechanism of intermittent ventilation on lung injury during cardiopulmonary bypass(CPB). Methods Twenty-four patients with rheumatic heart disease (RHD) were divided into two groups with random number table: treatment group (n=13),given intermittent ventilation once every 5 minutes during CPB; control group (n=11),no ventilation during CPB. Blood samples were obtained preoperatively. A bronchoalveolar lavage was performed at 2 hours after CPB. The numbers of granulocytes, total protein (TP) and tumor necrosis factor-alpha(TNF-α) content in the bronchoalveolar lavage fluids(BALF) were measured, and lung oxygenate index (OI) were measured preoperatively and 1 hour, 4 hours after CPB termination,respectively. Results The numbers of granulocytes, TP and TNF-α content of treatment group in the BALF were significantly lower than those of the control group (Plt;0.01, P=0.02,0.02),and the lung OI of treatment group at 1 hour and 4 hours after CPB termination was also significantly lower than that of the control group(Plt;0.05); a significant increase of lung OI occurred in both groups at 1 hour and 4 hours after CPB when compared with the same group at baseline before CPB(Plt;0.05). Conclusion Intermittent ventilation has the protective effects on lung injury during CPB by decreasing granulocytes adhesion and alleviating lung inflammatory reaction and endothelial cells injury.
【摘要】 目的 通过观察单肺通气患者术中氧合指数（oxygenation index，OI）、呼吸指数（respiratory index，RI）及动态肺顺应性（dynamic lung compliance，Cdyn）的变化，探讨高渗氯化钠溶液对术中单肺通气患者的肺保护作用。 方法 选择2009年12月-2011年2月完成的美国麻醉师协会分级为Ⅰ~Ⅲ级，心肺功能筛查、血常规、肝肾功能及凝血功能无明显异常，拟在全麻双腔气管插管下行开胸手术，术中需行单肺通气患者60例，随机分为高渗氯化钠组（A组）和对照组（B组），每组30例。A组在开始单肺通气后30 min快速输注7.5%高渗氯化钠溶液2 mL/kg，15 min内输注完毕，B组输注等量生理盐水，分别记录输注前（T1）、输注完毕时（T2）、输注后30 min（T3）、输注后1 h（T4）的OI、RI及Cdyn变化，并比较两组各时间点生命体征变化。 结果 两组患者OI、RI及Cdyn在T1、T2时差异无统计学意义（Pgt;0.05）；两组患者不同时间点平均动脉压、心率、脉搏血氧饱和度、中心静脉压、呼气末CO2分压比较差异无统计学意义（Pgt;0.05）；A组患者在T3、T4时的OI和Cdyn较B组明显升高，RI明显降低（Plt;0.05）；且A组患者在T3、T4时的OI和Cdyn较T1时明显增高，RI明显降低（Plt;0.05）。 结论 高渗氯化钠溶液能改善术中单肺通气患者的OI、RI及Cdyn，对肺功能有一定的保护作用。【Abstract】 Objective To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects. Methods Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared. Results OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (Pgt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (Pgt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (Plt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (Plt;0.05). Conclusion Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.
Objective To explore the prognostic value of preoperative pulmonary ventilation function for postoperative survival of patients with non-small cell lung cancer ( NSCLC) . Methods 146 NSCLC patients who underwent cured lung surgical resection between January 1, 2003 and December 31,2008 in Nanjing Drum Tower Hospital were recruited in the study. Pulmonary ventilation function was obtained preoperatively for each patient, including vital capacity ( VC) , forced vital capacity ( FVC) , forcedexpiratory volume in 1 second ( FEV1 ) , FEV1 /FVC, and peak expiratory flow ( PEF) . The effects of the above lung function variables on postoperative survival were evaluated by both univariate and multivariate Cox proportional hazard models. Kaplan-Meier method was used to assess the survival probabilities betweendifferent groups.Results The median survival time after surgery was 31. 0 months ( 95% CI 22. 55-39. 45) . VC% pred, FVC% pred and FEV1% pred showed significant associations with the risk of mortality in the NSCLC patients after surgery ( hazard ratios 0. 979-0. 981, P lt; 0. 05) . The survival time after surgery was significantly shorter in the patients with VC ≤ 80% predicted compared to those with VC gt; 80% predicted ( median survival time: 31. 0 months vs. 34. 0 months) . The same difference could be found between the patients with FVC≤80% predicted and those with FVC gt; 80% predicted ( median survival time: 27. 0 months vs. 43. 0 months) . There was also significant difference in median survival between the patients with FEV1 ≤80% predicted and those with FEV1 gt; 80% predicted ( median survival time: 17. 0 months vs. 44. 0 months) . Conclusion Preoperative pulmonary ventilation function parameters may be used to informclinical decisions and indicate the prognosis of NSCLC patients after surgery.
Regional cerebral oxygen saturation cerebral oxygen saturation(rScO2) monitoring by using near-infrared spectroscopy(NIRS) is a simple, sensitive, continuous and noninvasive method, which can detect the change in oxygen supply and demand. It has already draw attentions and applications during perioperative in recent years. The technique was firstly used in cardiac surgery, thereafter some studies found thoracic surgery which mostly used one-lung ventilation also was necessary to monitor rScO2. A series of studies confirmed there were correlations among perioperative adverse events and rScO2. In this paper, we reviewed the basic principle of rScO2, summarized the applications of rScO2 in cardiac and thoracic surgery, discussed the existing problems.