單側肺輪流換氣麻醉應用於胸腔鏡交感神經切除術

Alternative One Lung Ventilation Anesthesia for Bilateral Thoracoscopic Sympathectomy

何始生(Chee-Sang Ho) ； 高明見(Ming-Chien Kao)

《Acta Anaesthesiologica Sinica》 32卷1期 (1994/03) Pp. 1-6

摘要

手掌多汗（Hyperhidrosis）為一種原因不明的異常性手掌多汗，通常病人的腋窩和足底也有波及，且多有家族史。此病常見於亞熱帶的東方人，病患兩手濕淋淋明顯困擾日常社交活動甚至妨礙工作。目前已有多種療法譬如：口服或局部塗抹藥物或經背部交感神經切除術等。經背部交感神經切除術需要大的皮切傷口，其手術時間需要3－4小時，但自電視內視鏡日漸普遍，此種經胸內視鏡交感神經切除術已有逐漸取代傳統手術之趨勢。惟此等手術因為是在上胸腔內操作故必須維持手術側肺部的部份陷縮且短暫停止呼吸始能順利進行。本研究即應用雙管腔支氣管內管（Double－lumen endobronchial tube）施行交替性單側肺輪流換氣麻醉，使手術得能順利進行而安全完成，124位手汗症病人應用此法完成手術，術後病況良好，胸部X光追蹤檢查顯示僅極少數病例其一側胸腔殘留微量空氣，大多數病患主訴短期後胸部痛，大約術後4－5小時即逐漸減輕而消失。一般住院兩日，於術後第二日早上出院，較接受傳統手術治療所需之時日明顯縮短，可降低醫療成本與社會成本。根據我們的實際經驗，此種麻醉方法安全度高，誠為進行經胸腔內視鏡的手術所必需。

關鍵字

雙腔導管氣管內管 ； 單側肺輪流換氣麻醉 ； 胸腔鏡交感神經切除術 ； 多汗症

並列摘要

Palmar hyperhidrosis (PH) is a common disorder in the oriental subtropical area. There have been many therapeutic methods, such as: oral medication, local treatment and traditional surgical operation, but none of them has proved entirely satisfactory. Since the development of video endoscopic surgery, transthoracic endoscopic sympathectomy has been increasing day by day. This study consisted of 124 PH patients under alternative one lung ventilaton anesthesia for bilateral thoracoscopic laser sympathectomy. The age of patients ranged from 13 to 64 years, male 45 and female 79. The average anesthesia duration was 60 min. We used glycopyrrolate 0.03 mg/kg, decardon 1 mg/10 kg for premedication. Induction was with fentanyl 0.07 ml/kg, atracurium 0.6 mg/kg and thiopental 4 mg/kg. Maintenance was with isoflurane in 3L/min. oxygen inhalation. The alternative one lung ventilation anesthesia was achieved with double-lumen endobronchial tube. Fr 37, Fr 35, Fr 28 Sheridan Lt. double-lumen bronchial tube were used depending upon the sex and fudgement of the individual patient. All patients tolerated the procedure well so that sympathectomy could be performed smoothly and uneventfully. Immediately after the operation, a transient mild to moderate degree of difficult breathing and substernal discomfort were experienced in the majority of patients. These suffering often relieved spontaneously or with some common analgesic.

並列關鍵字

Double-lumen endobronchial tube (Bronchial Catheter) ； Alternative one lung ventilation anesthesia ； Thoracoscopic Surgery ； Hyperhidrosis