Abstract: Objective To evaluate selective lobar blockade in non-upper thoracic vertebrae tuberculosis anterior approach operation via right thoracotomy. Methods Thirty-eight patients with non-upper thoracic vertebrae tuberculosis admitted in Beijing Chest Hospital from May, 2012 to September,2013 undergoing anterior approach spinal operation via right thoracotomy were randomly divided to the double-lumen tube (OLV) group(n=19) and the selective lobar blockade(SLB) group(n=19). Anesthesia was induced and maintained routinely. The patients were intubated with F35 or F39 double-lumen tube in OLV group and were intubated with ID 7.5 or ID 8.0 enforced single-lumen tube and a endobronchial blocker into the bronchus intermedius in SLB group. The position of all endobronchial tube was ensured with fiberoptic bronchoscope. Ppeak, Pplat, Comp and arterial blood gas analysis was performed and recorded at the following time point: 10 mins after two lung ventilation on left lateral decubitus position(T₁), 30 mins after one lung ventilation or selective lobar blockade ventilation (T₂), 15 mins after two lung ventilation resumed(T₃).  Results PaO₂ and SaO₂ of group SLB were higher than those of group OLV(P<0.05) at 30 mins after one lung ventilation or selective lobar blockade ventilation (PaO₂: (189.4±58.2) mm Hg，(145.6±50.4) mm Hg, t=4.28, P=0.00); SaO₂: 99.6%±0.3%, 97.5%±1.0%,(t=8.21, P=0.00). Ppeak and Pplat of group SLB were lower than those of group OLV(P<0.05) at 30 mins after one lung ventilation or selective lobar blockade ventilation (Ppeak: (18.1±3.2) cm H₂O，(20.5±4.1) cm H₂O，t=2.15，P=0.04); Pplat: (16.3±3.2) cm H₂O, (20.2±2.4) cm H₂O，(t=3.94, P=0.00). Comp of group SLB were higher than those of group OLV at 30 mins after one lung ventilation or selective lobar blockade ventilation ((34.8±14.5) ml/cmH₂O, (26.4±15.2) ml/cmH₂O，t=6.07, P=0.00). No statistical difference existed in surgery field (χ²=0.36, P=0.55).  Conclusion Selective right lower lobar blockade can improve oxygenation and indexes of respiratory mechanics of patients undergoing non-upper thoracic vertebrae tuberculosis anterior approach operation via right thoracotomy. It doesn’t affect the operation field exposure and operative procedure.

Key words: Tuberculosis, spinal/surgery, Thoracic vertebrae, Surgical procedures, elective, Catheterization, Bronchi, Septal occluder device, Pulmonary ventilation