Objective To observe the clinical responses and hemodynamic changes of single chamber endotracheal intubation general anesthesia applied to thoracoscopic resection of esophageal carcinoma under carbon dioxide pneumothorax. Method Sixty [ASA I ~ II, NYHA I ~ II, hight (148.57 ± 10.95) cm, weight (40.52 ± 3.97) kg] patients who were light weight, short height, and underwent thoracoscopic resection of esophageal carcinoma in pneumothorax with filling carbon dioxide under general anesthesia of tracheal intubation with single lumen were selected. CO2gas (6 ~ 8 L/min) was slowly inserted into the operative side thoracic cavity to maintain intrathoracic pressure 6 ~ 8 mmHg (1 mmHg=0.133 kPa), heart rate (HR), blood pressure (BP), central venous pressure (CVP), pulse oxygen saturation (SpO2), airway pressure (PaW), partial pressure of end-tidal carbon dioxide (PETCO2) and other indicators and so on, were collected at the 5 minutes before artificial pneumothora (T1), and at the 5 minutes (T2), 15 minutes(T3), 30minutes (T4), 60 minutes (T5), 100 minutes (T6) after artificial pneumothorax, and 10 minutes at the end of thoracic operation (T7), Samples of arterial blood gases were obtained at the same time. Results All cases were successfully completed by thoracoscopic surgery, significant arrhythmias and severe complications were not found at each time point; After CO2pneumothorax, HR, CVP, PaW, PETCO2and PaCO2at T2~ T6increased significantly than those at T1(P < 0.05); but BP, Arterial oxygen pressure (PaO2) and blood pH value decreased significantly at T2~ T6than those at T1(P < 0.05); SpO2at T3and T4was significantly lower than that at T1(P < 0.05), Although SpO2also decreased at T5and T6, there was no significant differences comparing to at T1(P > 0.05). After T7, most of the remaining indicators were restored to the base level excep that CVP remains high. Conclusion When patients with low weight and short stature underwent tracheal intubation under single lumen anesthesia for thoracoscopic resection of esophageal cancer under carbon dioxide pneumothorax, their hemodynamics were relatively stable,and all the indexes of respiration and arterial blood gas were within the acceptable range, It was a feasible, relatively safe method of anesthesia for such patients who could enjoy thoracoscopic techniques.%目的 观察单腔气管插管全麻应用于二氧化碳CO2气胸下胸腔镜食管癌根治术的麻醉临床反应和血流动力学的变化.方法 选择在单腔气管插管全麻下行胸腔镜食管癌根治术及低体重和身高矮的患者[美国麻醉医师协会(ASA)分级Ⅰ和Ⅱ级、美国纽约心脏病学会(NYHA)分级Ⅰ和Ⅱ级,体重(40.52± 3.97)kg,身高(148.57±10.95)cm]60例,在术侧胸腔中缓慢充CO2气体(6~8 L/min),维持胸内压6~8 mmHg,分别采集人工气胸前5 min(T1)、人工气胸后5 min(T2)、人工气胸后15 min(T3)、人工气胸后30 min(T4)、人工气胸后60 min(T5)、人工气胸后100 min(T6)、胸腔手术结束10 min(T7)的心率(HR)、血压(BP)、中心静脉压(CVP)、脉搏血氧饱合度(SpO2)、气道压(PaW)及呼气末二氧化碳分压(PETCO2)等指标和动脉血气指标.结果 所有病例均顺利完成胸腔镜手术,各时间点均未发现明显的心律失常和严重并发症;CO2气胸后,T2~T6时的HR、CVP、PaW、PETCO2和动脉血二氧化碳分压(PaCO2)较T1时明显升高(P <0.05);T2~T6时BP、动脉血氧分压(PaO2)和血气pH值较T1时明显下降(P <0.05);SpO2在T3、T4时比T1时明显降低(P <0.05),T5、T6时降低但差异无统计学意义(P >0.05).T7后除CVP仍高外,其余大多数指标恢复至基础值水平.结论 低体重和身高矮小患者实施单腔气管插管全麻应用于CO2气胸下胸腔镜食管癌根治术时,其血流动力学相对基本稳定,为这类患者享有胸腔镜技术提供了一种可行的、相对安全的麻醉方法.
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