支气管插管与支气管封堵器对婴幼儿胸腔镜手术后转归影响的对比分析  

Comparative analysis of the effects of bronchial intubation and bronchial blocker on the outcomes of thoracoscopic surgery in infants and small children

作　　者：李泳鑫 魏国[1] 陈刚[1] 李帆[1] 潘守东[1] Li Yongxin;Wei Guo;Chen Gang;Li Fan;Pan Shoudong(Department of Anesthesiology,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院麻醉科,北京100020

出　　处：《中华医学杂志》2024年第23期2154-2159,共6页National Medical Journal of China

基　　金：北京惠康仁爱公益基金会项目(RCLX2315003)

摘　　要：目的比较支气管插管和支气管封堵器对婴幼儿胸腔镜手术后转归的影响。方法回顾性纳入2019年1月至2023年8月首都儿科研究所附属儿童医院择期行全身麻醉下单肺通气胸腔镜手术患儿387例,其中男210例,女177例,年龄(17.5±8.3)个月。根据患儿术中单肺通气方式分为支气管插管组和支气管封堵器组,并采用倾向性评分匹配最邻近匹配法匹配年龄因素,最终支气管插管组纳入258例,支气管封堵器组纳入129例。主要观察指标为两组患儿术后肺部并发症发生率。次要观察指标包括两组患儿术中低氧血症发生率、术毕氧合指数、术后拔除气管导管时间、术后住院时间和医疗费用等转归指标。结果支气管插管组和支气管封堵器组术后肺部并发症发生率分别为15.5%(40/258)和12.4%(16/129),术中低氧血症发生率分别为20.2%(52/258)和16.3%(21/129),术毕氧合指数[M(Q_(1),Q_(3))]分别为306(269,323)和311(274,336)mmHg(1 mmHg=0.133 kPa),术后拔除气管导管时间分别为(9.2±4.5)和(8.9±4.2)min,术后住院时间分别为(5.5±0.6)和(5.5±0.5)d,医疗费用分别为(3.4±0.6)和(3.5±0.6)万元,差异均无统计学意义(均P>0.05)。结论支气管插管和封堵器两种方式均可用于婴幼儿胸腔镜手术单肺通气,不影响患儿术后转归。Objective To compare the effects of bronchial intubation and blocker on the outcomes of thoracoscopic surgery in infants and small children.Methods A total of 387 children,including 210 males and 177 females,aged(17.5±8.3)months,who underwent elective thoracoscopic surgery under general anesthesia in Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2019 to August 2023 were retrospectively analyzed.The children were divided into bronchial intubation group and bronchial blocker group according to the intraoperative single-lung ventilation mode.After matching the age factor using the propensity score matching with nearest neighbor matching method,258 cases were finally included in the bronchial intubation group,and 129 cases were included in the bronchial blocker group.The primary outcome was the incidence of postoperative pulmonary complications in two groups.The secondary outcomes included the incidence of intraoperative hypoxemia,postoperative oxygenation index,postoperative extubation time,the length of postoperative hospitalization and the total medical expenses during hospitalization between the two groups.Results The incidence of postoperative pulmonary complications in the bronchial intubation group and bronchial blocker group was 15.5%(40/258)and 12.4%(16/129),the incidence of intraoperative hypoxemia was 20.2%(52/258)and 16.3%(21/129),the postoperative oxygen indexes were 306(269,323)and 311(274,336)mmHg(1 mmHg=0.133 kPa),the extubation time was(9.2±4.5)and(8.9±4.2)min,the length of postoperative hospitalization was(5.5±0.6)and(5.5±0.5)days and the total medical expenses were(34±6)and(35±6)thousand yuan,with no statistically significant differences between the two groups(all P>0.05).Conclusion Both bronchial intubation and blocker can be used for one lung ventilation in thoracoscopic surgery for infants and small children,without affecting the postoperative outcomes.

关 键 词：儿童 胸腔镜 术后肺部并发症 倾向性评分匹配 

分 类 号：R726.1[医药卫生—儿科]