不同麻醉通气方法在胸外科微创手术培训中的应用与比较

doi:10.12300/j.issn.1674-5817.2023.135

实验动物与比较医学 ›› 2024, Vol. 44 ›› Issue (1): 97-104.DOI: 10.12300/j.issn.1674-5817.2023.135

不同麻醉通气方法在胸外科微创手术培训中的应用与比较

刘意抒¹(), 赵善民², 蔡丽萍³()()

^1.海军军医大学第三附属医院医学模拟中心, 上海 200438
^2.海军军医大学基础医学院实验动物学教研室, 上海 200433
^3.海军军医大学第一附属医院临床教育中心, 上海 200433

收稿日期:2023-09-27 修回日期:2023-12-04 出版日期:2024-02-25 发布日期:2024-03-07
通讯作者: 蔡丽萍（1983—），女，硕士，主管技师，研究方向：实验动物应用研究、医学模拟教育。E-mail： ccg9115@126.com。ORCID：0009-0003-5485-5506
作者简介:刘意抒（1988—），女，硕士，讲师，研究方向：医学模拟教育、院校教育。E-mail： yishu1128@163.com。ORCID：0009-0002-2989-4557

Application and Comparison of Different Anesthetic Ventilation Methods in Minimally Invasive Thoracic Surgery Training

Yishu LIU¹(), Shanmin ZHAO², Liping CAI³()()

^1.Medical Simulation Center of the Third Affiliated Hospital of Naval Medical University, Shanghai 200438, China
^2.Department of Laboratory Animal Science, College of Basic Medical Sciences, Naval Medical University, Shanghai 200433, China
^3.Clinical Education Center of the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China

Received:2023-09-27 Revised:2023-12-04 Published:2024-02-25 Online:2024-03-07
Contact: CAI Liping (ORCID: 0009-0003-5485-5506), E-mail: ccg9115@126.com

摘要/Abstract

摘要：

目的对比单肺通气和小潮气量双肺通气麻醉方法在实验猪胸外科微创手术培训中的应用效果和安全性。方法将40例接受手术机器人胸外科手术的实验猪随机分为双肺通气组（n=20）和单肺通气组（n=20）。双肺通气组施行单腔气管插管，术中使用小潮气量快呼吸频率联合二氧化碳气胸的麻醉通气方法。单肺通气组在纤维支气管镜引导下放置双腔支气管导管进行单肺通气。比较两组动物的麻醉实施指标，包括术中心率（heart rate，HR）、无创平均血压（mean blood pressure，MAP）、呼气末二氧化碳（end-tidal carbon dioxide，ETCO₂）和血氧饱和度（oxygen saturation，SpO₂）等生命体征数值以及手术培训考核情况。结果两组动物的插管成功率均为100%，术中均无动物死亡。双肺通气组插管完成时间短于单肺通气组（P＜0.001）。组内比较中，双肺通气组在胸科手术开始后30 min（T₁）和手术完成时（T₃）的SpO₂含量显著高于手术开始60 min（T₂）（P＜0.05），T₂和T₃的ETCO₂、HR和MAP显著高于T₁（P＜0.05）；单肺通气组中，T₁和T₃的SpO₂含量显著高于T₂（P＜0.05），ETCO₂含量随时间逐渐上升（P＜0.05）。在同一时间点的组间比较中，双肺通气组的SpO₂含量在所有时间点（T₁、T₂、T₃）均显著高于单肺通气组（P＜0.05）。结论单肺通气和双肺通气的麻醉方法都具有对术中动物生命体征的影响可控且对手术操作培训的影响较小的优点，皆可满足胸外科手术机器人培训需求。单肺通气在肺叶切除术中体验感更好，而使用小潮气量双肺通气的麻醉方法较单肺通气具有实施简便、无需额外购置设备的优点，可作为实验猪胸腔镜手术时的一种麻醉补充选择。

关键词: 实验猪, 麻醉, 胸腔镜手术, 气道管理, 手术机器人培训

Abstract:

Objective To compare the effectiveness and safety of one-lung ventilation and small tidal volume two-lung ventilation anesthesia methods in the training of minimally invasive thoracic surgery on experimental pigs. Methods Forty experimental pigs undergoing robotic thoracic surgery were randomly divided into two groups: two-lung ventilation group (n=20) and one-lung ventilation group (n=20). The two-lung ventilation group underwent single-lumen tracheal intubation, utilizing a small tidal volume with a fast respiratory rate combined with carbon dioxide pneumothorax for anesthesia ventilation during the operation. The one-lung ventilation group received one-lung ventilation using a double-lumen bronchial catheter placed under fiberoptic bronchoscopic guidance. The anesthesia implementation indexes from the two groups were compared, including the values of vital signs such as operative heart rate (HR), noninvasive mean blood pressure (MAP), end-tidal carbon dioxide (ETCO₂), and oxygen saturation (SpO₂), as well as the assessment of surgical training performance. Results The intubation success rate for animals in both groups was 100%, with no intraoperative deaths. The intubation completion time was significantly shorter in the two-lung ventilation group compared to the one-lung ventilation group (P < 0.001). Within each group, SpO₂ levels were significantly higher in the two-lung ventilation group at 30 minutes after the start of thoracic surgery (T₁) and at surgery completion (T₃) compared to 60 minutes after the start of surgery (T₂) (P<0.05). ETCO₂, HR, and MAP were significantly higher at T₂ and T₃ compared to T₁(P<0.05). In the one-lung ventilation group, SpO₂ levels were significantly higher at T₁ and T₃ compared to T₂ (P<0.05), while ETCO₂ levels gradually increasing over time (P<0.05). In the between-group comparisons at the same time points, SpO₂ levels of the two-lung ventilation group were significantly higher than those of the one-lung ventilation group at all time points (T₁, T₂, T₃) (P<0.05). Conclusion Both one-lung ventilation and two-lung ventilation anesthesia methods are effective and safe for use in surgical training, with controllable effects on intraoperative animal vital signs and minimal impact on surgical operation training, meeting the needs of robotic thoracic surgery training. One-lung ventilation provides a better experience during pneumonectomy procedures, while small tidal volume two-lung ventilation is easier to implement and does not require additional equipment purchase, making it a feasible supplemental anesthesia option for thoracoscopic surgery on experimental pigs.

Key words: Experimental pig, Anesthesia, Thoracoscopy surgery, Airway management, Surgical robot training

中图分类号:

R-332

刘意抒, 赵善民, 蔡丽萍. 不同麻醉通气方法在胸外科微创手术培训中的应用与比较[J]. 实验动物与比较医学, 2024, 44(1): 97-104.

Yishu LIU, Shanmin ZHAO, Liping CAI. Application and Comparison of Different Anesthetic Ventilation Methods in Minimally Invasive Thoracic Surgery Training[J]. Laboratory Animal and Comparative Medicine, 2024, 44(1): 97-104.

图/表 5

表1 两组动物麻醉实施指标比较

Table 1 Comparison of anesthesia implementation indexes between two groups of animals （）

指标

Indexes

双肺通气组 (n=20)

Two-lung ventilation group

单肺通气组 (n=20)

One-lung ventilation

group

t值

P值

动物体质量/kg

Animal body weight/kg

插管用时/min

Intubation time/min

插管成功率/%

Intubation success rate/%

100±0

图1 两组动物的生命体征指标比较注：A～D，人工气胸建立后15 min（T1）、30 min（T2）及手术完成（T3）时的血氧饱和度（SpO2）、呼气末二氧化碳（ETCO2）、心率（HR）、平均血压（MAP）数值结果。TLV为双肺通气组（n=20），OLV为单肺通气组（n=20）。与T1比较，*P<0.05；与T2比较，# P<0.05；与TLV比较，& P<0.05.

Figure 1 Comparison of vital signs indices between two groups of animalsNote：A-D， the numerical values of blood oxygen saturation （SpO2）， end-expiratory carbon dioxide （ETCO2）， heart rate （HR）， and mean blood pressure （MAP） at 15 minutes （T1）， 30 minutes （T2） after the establishment of artificial pneumothorax， and completion of surgery （T3）. TLV represents the two-lung ventilation group (n=20), while OLV represents the one-lung ventilation group (n=20). Compared with T1, *P<0.05; Compared with T2, #P<0.05； Compared with the TLV group, &P<0.05.

图2 两组动物手术培训考核情况比较注：A～C，手术过程中机械臂碰撞次数（次）、手术时间（min）和出血量（mL）数值结果比较。TLV为双肺通气组（n=20），OLV为单肺通气组（n=20）。与双肺通气组相比，nsP>0.05。

Figure 2 Comparison of surgical training assessment between the two groups of animal surgeriesNote：A-C， the number of robotic arm collisions (times), surgical time (min), and blood loss (mL) during the surgical procedure. TLV represents the two-lung ventilation group (n=20), while OLV represents the one-lung ventilation group (n=20). nsP>0.05, vs TLV group.

图3 两组动物胸腔镜下手术视野比较注：A为双肺通气组胸腔镜下视野，其中白色箭头指示小潮气量通气模式下的肺叶。B为单肺通气组胸腔镜下视野，其中白色箭头指示已塌陷的肺叶。

Figure 3 Comparison of the thoracoscopic surgical field between the two groups of animalsNote：Figure A shows the view under thoracoscopy of the two-lung ventilation group， with the white arrow indicating the lung lobe under low tidal volume ventilation mode. Figure B shows the view under thoracoscopy of the one-lung ventilation group， with the white arrow indicating the collapsed lung lobe.

图4 手术机器人胸外科专项培训中实验猪的麻醉策略与方法

Figure 4 Anesthesia strategies and methods for experimental pigs in specialized training for robotic thoracic surgery

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[15]	汪静，丁隽，姜莹，袁春萍，严国锋，杨伟敏，陈学进. 两种麻醉剂对KM小鼠麻醉效果的比较[J]. , 2009, 29(2): 132-134.

不同麻醉通气方法在胸外科微创手术培训中的应用与比较

Application and Comparison of Different Anesthetic Ventilation Methods in Minimally Invasive Thoracic Surgery Training

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