Influence of bipulmonary ventilation combined with CO₂ pneumothorax on blood gas analysis and hemodynamics in patients with thoracolaparoscopic radical resection for esophageal cancer

  Objective  To compare the influence of bipulmonary ventilation combined with CO₂ pneumothorax and one lung ventilation on blood gas analysis and hemodynamics in patients with thoracolaparoscopic radical resection for esophageal cancer.

  Methods  Eighty-one patients with thoracolaparoscopic radical resection for esophageal cancer were divided into single lung ventilation group (n=40) and bipulmonary ventilation group (n=41) according to the intraoperative ventilation methods. The single lung ventilation group was given one lung ventilation with double lumen tube, and the bipulmonary ventilation group was given bipulmonary ventilation with single lumen tube and CO₂ pneumothorax. The perioperative indexes, intraoperative blood gas analysis, hemodynamic indexes and the incidence of postoperative complications were compared between the two groups.

  Results  The postoperative hospital stay in the bipulmonary ventilation group was significantly shorter than that in the single lung ventilation group (P < 0.05). The partial pressures of arterial carbon dioxidep_a(CO₂) at 40 min (T₂), 60 min (T₃) after establishment of artificial pneumothorax and the end of surgery (T₄) in both groups were significantly higher than those at 20 min after establishment of artificial pneumothorax (T₁) in the same group (P < 0.05), and the levels of p_a(CO₂) at T₂ and T₃ in the bipulmonary ventilation group was significantly higher than that in the single lung ventilation group (P < 0.05); the partial pressures of arterial oxygenp_a(O₂) at T₂, T₃ and T₄ in both groups were significantly lower than those at T₁ in the same group (P < 0.05), and the levels of p_a(O₂) at T₂, T₃ and T₄ in the bipulmonary ventilation group were significantly higher than those in the single lung ventilation group (P < 0.05). The mean arterial pressures (MAP) at T₂ in both groups were significantly higher than that at T1 in the same group (P < 0.05), but the MAP at T₂ in the bipulmonary ventilation group was significantly lower than that in the single lung ventilation group (P < 0.05); the heart rates (HR) at T₂ and T₃ in both groups were significantly higher than that at T₁ in the same group (P < 0.05), and the HR at T₂ and T₃ in the bipulmonary ventilation group was significantly higher than that in the single lung ventilation group (P < 0.05). The incidence of postoperative complications in the bipulmonary ventilation group was 19.51%, which was significantly lower than 42.50% in the single lung ventilation group (P < 0.05).

  Conclusion  Compared with one lung ventilation, bipulmonary ventilation combined with CO₂ pneumothorax is more suitable for patients with thoracolaparoscopic radical resection for esophageal cancer, which has little effect on intraoperative respiration and circulation, less postoperative complications, faster recovery and shorter hospital stay.