Lobektomi Olgularında Uyguladığımız Tek Akciğer Ventilasyonunun Değerlendirilmesi

Öz

Amaç: Tek akciğer ventilasyonu göğüs cerrahisinde lobektomi sırasında anestezide sıklıkla çift lümenli tüplerle uygulanan bir yöntemdir. Akciğerlerin izolasyonu morbidite ile mortaliteyi azaltırken, cerrahinin görüş alanı ve kalitesini artırır. Çalışmaya aldığımız akciğer rezeksiyonu yapılan olguların preoperatif hazırlıklarının postoperatif dönemdeki prognozunu belirlemedeki yeterliliğini sorgularken, tek akciğer ventilasyonunun perioperatif ve erken postoperatif döneme etkisini araştırmayı planladık. Gereç ve Yöntemler: Torakotomi yapılan toplam 37 olgudaki anestezi ve akciğer ventilasyon yöntemleri ile ilgili veriler retrospektif olarak incelenerek, preoperatif, intraoperatif ve postoperatif veri kayıtları analiz edildi. Tek akciğer ventilasyonu uyguladığımız olgulardaki anestezik yönetimdeki verilerle beraber intraoperatif hemodinamik ve kan gazı değişiklikleri ile postoperatif dönemdeki kan gazları kaydedilmiştir.Bulgular: Tek akciğer ventilasyonu uyguladığımız 37 olgunun 6’sında bronşial ve univent bloklu, diğerlerinde ise çift lümenli tüp kullanılmıştır. Preoperatif, operasyon sonu ve ekstübasyon sonrası alınan kan gazlarınında pH, p CO2, pO2, SO2, Lac, HCO3 ve BE kendi aralarında karşılaştırıldığında ise; Operasyon sonu ve postoperatif pH değerinin, preoperatif pH değerine göre daha asidoz özellikte olduğu görülmüştür p=0.0001 . On olguda hipoksemi gelişmiş, bunların %56,8 ile sigara öyküsü ve uzamış cerrahi süresi saptanmıştır. Çeşitli nedenlere bağlı olarak yapılan akciğer rezeksiyonlarda postoperatif dönemde en sık rastlanılan komplikasyon ise atelektazi olarak kaydedilmiştir.Sonuç: Toraks cerrahisi geçirecek olgularda daha ayrıntılı anestezi kayıtlarının alınması, bu olgulara ait yeterli bir veri tabanı oluşmasını ve yapılacak retrospektif çalışmalara yol gösterici olacaktır

Anahtar Kelimeler

• Torakotomi, Lobektomi, Tek akciğer ventilasyonu, Mekanik ventilasyon, Solunum mekaniği, Hipoksemi, Kan gazı

Evaluation of One-Lung Ventilation in Patients Undergoing Lobectomy Operations

Abstract

Objective: Single lung ventilation is a method often applied with double-lumen tubes in anesthesia during lobectomy in thoracic surgery. Isolation of the lungs reduces morbidity and mortality while increasing the field of vision and the quality of surgery. While questioning the sufficiency of preoperative preparations in determining the prognosis in the postoperative period of the cases in which lung resection was practiced that we included in the study, we planned to study the impact of single lung ventilation on the perioperative and early postoperative period.Material and Methods: Data regarding anesthesia and lung ventilation methods used in a total of 37 cases in which thoracotomy was practiced were studied retrospectively and the preoperative, intraoperative and postoperative data records were analyzed. Together with data related to anesthetic administration for the cases in which we applied single-lung ventilation, intraoperative hemodynamic and blood gas changes and blood gases in the postoperative period were recorded.Results: Of the 37 cases where single-lung ventilation was used, bronchial and Univent blockers were used in 6 cases and double-lumen tubes in the others. Blood gas tests performed preoperatively, after the operation and after extubation included pH, p CO2, pO2, SO2, Lac, HCO3 and BE measurements, and when compared among each other, it was observed that end of surgery and postoperative pH values were lower than preoperative pH values p=0.0001 . Hypoxemia had developed in ten cases of which 56.8% had a history of cigarette smoking and prolonged surgery duration. The most common complication confronted during the postoperative period after lung resection performed for various reasons was noted to be atelectasis. Conclusion: More detailed anesthesia records in cases undergoing thoracic surgery will enable creating a sufficient database for such cases and guide future retrospective studies

Keywords

• Thoracotomy, Lobectomy, Single-lung ventilation, Mechanical ventilation, Respiratory mechanics, Hypoxemia, Blood gas

Kaynakça

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