以胸腔內視鏡進行交感神經切除術治療手汗症之麻醉經驗：比較雙腔支氣管內管及喉罩通氣的結果

Experience of Anesthesia during Transthoracic Endoscopic Sympathectomy for Palmar Hyperhidrosis: Comparison between Double-Lumen Endobronchial Tube Ventilation and Laryngeal Mask Ventilation

謝宜哲(Yi-Jer Hsieh) ； 陳錦銘(Chin-Ming Chen) ； 林秀櫻(Hsiu-Ying Lin) ； 楊騰方(Teng-Fun Young)

《Acta Anaesthesiologica Sinica》 32卷1期 (1994/03) Pp. 13-20

摘要

本院於過去一年中為36位多汗症病患進行了胸腔鏡交感神經燒灼，第一組病患17名接受了雙腔支氣管內管通氣的麻醉方式；第二組病患則有19人接受喉罩通氣的麻醉方式。使用雙腔支氣管內管通氣之病患於右肺塌陷燒灼右側交感神經時，血氧飽和濃度自術前的99.65±0.70 mmHg下降至開始燒灼時的95.12±5.48 mmHg、及燒灼5分鐘時的94.25±5.41 mmHg待右側手術完畢才又回到99.53±0.62 mmHg。同組病患在左肺塌陷以燒灼左側交感神經時，血氧飽和濃度自術前的99.59±0.62 mmHg下降至開始燒灼時的97.35±3.06 mmHg、及燒灼5分鐘時的97.82±2.53 mmHg，待左側手術完畢時回到99.65±0.49 mmHg。使用喉罩通氣之19位病患中，燒灼右側交感神經節時，血氧飽和濃度從術前的99.68±0.58 mmHg，開始燒灼時為99.74±0.45 mmHg、燒灼5分鐘時為99.79±0.42 mmHg，燒灼完畢時為99.84±0.38 mmHg；燒灼左側交感神經節時，血氧飽和濃度的變化自燒灼前的99.84±0.39 mm Hg到開始燒灼時為99.42±1.50 mmHg、燒灼5分鐘時為99.47±1.46 mm Hg，到燒灼完畢時為99.74±0.59 mmHg。使用雙腔支氣管內管通氣組手術耗時52.35±18.30 mmHg分鐘，而使用喉罩通氣組則耗時32.11±8.39 mmHg分鐘。統計分析顯示：使用雙腔支氣管內管通氣或使用喉罩通氣之病患，其血氧飽和濃度變化，兩組確有差異存在（p ＜0.001）；進一步分析不同時間與該側劃刀前血氧飽和濃度的差距，我們發現使用雙腔支氣管內管通氣病患於開始燒灼與燒灼5分鐘時，血氧飽和濃度的下降具有意義（p值皆小於0.05）；相對地在使用喉罩通氣組病患身上，在開始燒灼與燒灼5分鐘時血氧飽和濃度變化則沒有類似的下降（p值大於0.05）。使用喉罩通氣麻醉病患在交感神經燒灼中血氧飽和濃度都能保持的很好，與劃刀前沒有差異。與雙腔支氣管內管病患相較，喉罩組病患血氧飽和濃度也明顯地比較能夠維持在一個較安全的範圍，原因可能是由於：（1）雙腔支氣管內管位置不易放置妥當，（2）單肺通氣造成肺血管分流的存在或肺血管缺氧收縮未及運轉所致。因此我們認為長期以來使用雙腔支氣管內管達成單肺通氣來麻醉穿胸內視鏡交感神經切除術病患，在使用不當時仍具有危險性！

關鍵字

多汗症 ； 穿胸內視鏡 ； 交感神經切除術 ； 血氧飽和濃度 ； 雙腔支氣管內管 ； 喉罩

並列摘要

In the past year we had 36 patients operated for transthoracic endoscopic sympathectomy to treat palmar hyperhidrosis. The first group composed of 17 patients receiving anesthesia with double-lumen endobronchial-tube ventilation from July-92 to April-93, and the second group composed of 19 patients receiving anesthesia with laryngeal mask ventilation from April-93 to August-93. During right lung collapse for sympathectomy, the first group patients' SaO_2 (oxygen saturation) decreased from 99.65 ± 0.62 mmHg (pre-operation) to 95.12 ± 5.48 mmHg (at cauterization), 95.24 ± 5.41 mmHg (5 minutes after cauterization) and resumed 99.53 ± 0.62 mmHg after the procedure completed. During left lung collapse for left side sympathectomy, the same group patients' SaO_2 decreased from 99.59 ± 0.62 mmHg to 97.35±3.06 mmHg, 97.82±2.53 mmHg and resumed 99.65 ± 0.49 mmHg respectively. The second group using laryngeal mask ventilation had SaO_2 changes during right side sympathectomy from 99.68 ± 0.58 mmHg (pre-cauterization) to 99.74±0.45 mmHg (when cauterization), 99.79 ± 0.42 mmHg (5 minutes after cauterization) and resumed 99.84±0.37 mmHg after the procedure completed. During left side sympathectomy the second group patients' SaO_2 changed from 99.84±0.39 mmHg to 99.42± 1.50 mmHg, 99.47 ± 1.46 mmHg and resumed 99.74±0.59 mmHg respectively. After 2-Way ANOVA with repeated measures of the SaO_2 value, we could see that no matter what side operation, there were differences existed between these two group (＜0.001). After further analysis, we could attribute these differences to the decrease of SaO_2 of the endobronchial tube group at cauterization and 5' after cauterization (p＜0.05). On the contrast, the laryngeal group had no such decrease of SaO_2 (p ＞ 0.05). We could see that the SaO_2 of the patients using laryngeal mask ventilation remained nearly the same as pre-operation. Compared with the patients using double-lumen endobronchial-tube ventilation, the second group could keep their oxygenation in a safer range. The differences between these two groups might be attributed to two factors: double-lumen endobronchial-tube malposition and development of shunting during one-lung ventilation. On the other hand, the second group didn't take more time to perform the procedure. Obviously, it is not necessary and may be dangerous to anesthetize patients by one-lung ventilation with double-lumen endobronchial-tube in transthoracic endoscopic sympathectomy.

並列關鍵字

Hyperhidrosis ； Transthoracic endoscopy ； Sympathectomy ； Oxygen saturation ； Double-lumen endobronchial tube ； Laryngeal mask