Coopdech支气管堵塞导管行左下肺叶隔离的可行性  

The feasibility of selective left lower lobar blockade based on Coopdech endobronchial blocker tube

作　　者：叶靖[1,2] 张朝群[1] 古妙宁[1] 秦再生[1] 蔡开灿[3] 蔡瑞君[3] 

机构地区：[1]南方医科大学南方医院麻醉科,广州市510515 [2]广州医学院第一附属医院麻醉科工作 [3]南方医科大学南方医院胸外科

出　　处：《国际麻醉学与复苏杂志》2010年第1期37-41,共5页International Journal of Anesthesiology and Resuscitation

基　　金：广州市科技局科技成果重点推广计划项目（2008C13G011）

摘　　要：目的 观察Coopdech支气管堵塞导管对肺功能正常的下段食管癌根治术患者作左下肺叶隔离的可行性，以及对患者肺顺应性、吸气峰压和氧合作用的影响。方法拟行左侧剖胸下段食管癌根治术患者30例，ASAⅠ～Ⅱ级，按随机数字表法，随机分成支气管堵塞导管组（BB组）和左双腔支气管导管（double-lumen endobronchial tube，DLT）组（DLT组），每组15例。丙泊酚靶控输注静脉诱导后，BB组插入8样单腔气管导管．纤维支气管镜引导9Fr Coopdech支气管堵塞导管置入左下肺叶支气管，DLT组插入左DLT，2组均作双肺间歇正压通气。20min后摆放右侧卧位，DLT组行右单肺通气，BB组对堵塞导管套囊充气行右肺和左上肺叶通气。20min后手术开始，全程采用丙泊酚靶控输注维持麻醉，间歇追加舒芬太尼和顺阿曲库铵。于双肺通气后20min（T1），右单肺通气或右肺和左上肺叶通气后20min（T2），开胸见左肺或左下肺叶完全萎陷后（L），术毕拔出气管导管前（T4）行动脉血气分析，记录肺顺应性和吸气峰压，并请手术医生在开胸后即刻评价术野清晰度。观察期间，机械通气参数不变。术后第1天作动脉血气分析和胸片检查。结果2组患者的术野评价，各时点pH、动脉二氧化碳分压，T1的动脉氧分压、吸气峰压和肺顺应性差异无统计学意义。在R—T4时点，BB组的PaO2分别为（220±56）mmHg、（188±57）mgHg、（208±24）mmHg，高于DLT组（146±38）mmHg、（140±36）mmHg、（157±33）mmHg；肺顺应性分别为（36±9）ml／cmH2O，高于DLT组（24±6）ml／cmH2O，（35±12）ml／cmH2O，BB组的吸气峰压分别为（17．7±2．9）cmH20、（17．8±3．2）cmH2O、（14．8±2．2）cmH2O，低于DLT组的（21．7±3．6）cmH2O、（22．6±2．6）cmH2O，（16．8±1．8）cmH2O（P〈0．05）。BB组术后无肺不张病例，DLT组有1例发生左下肺不张。结论支气管堵Objective To observe the feasibility of selective left lower lobar blockade by Coopdech endobronchial blocker tube （BB）in patients with normal spirometry during left-sided lower esophageal surgery, and the effects on dynamic lung compliance （Cdyn）, peak inspiratory airway pressure （Ppeak）and arterial oxygenation. Methods 30 patients（aged 44-64 yr）scheduled for leftsided lower esophageal surgery were allocated randomly to two groups： Group BB or group double-lumen endobronchial tubes（DLT） （n=15）. Anesthesia was induced and maintained with Propofol by target controlled infusion, administered sufentanil and cisatracurium intravenously if needed. The left-sided DLT was placed in the DLT group and an 8.0-mm internal diameter single-lumen endotracheal tube was used in the BB group and 9 French Coopdech blocker was advanced into the left lower lobar bronchus with the guidance of a fiberoptic bronchoscope in the latter group. The variables recorded were Ppeak, Cdyn and arterial blood gas analyses data at four surgical times： 20 minutes after two-lung ventilation in supine position （T1）, 20 mimltes after initiation of one-lung ventilation or selective left lower lobar blockade by inflating BB balloons in right lateral decubitus position （T2）, total collapse of left lung or left lower lobe after the pleura was opened（T3） and before tracheal extubation（T4）. Tidal volume and respiratory rate were kept constant at each time. Once the pleura were opened, the effectiveness of lung collapse was evaluated by the surgeon who performed the surgery. Chest radiograph and arterial blood gas analyses were performed in the first postoperative day. Results The groups were comparable with regard to rank of surgical exposnre; pH, PaCO2 from T1 to T4; Cdyn, Ppeak, PaO2 at T1. Significant trends were found toward a higher decrease in Ppeak [（17.7±2.9） cm H2O vs （21.7±3.6） cm H20 in T2, （17.8±3.2） cm H2O vs （22.6±2.6） cm H2O in T3, （14.8±2.2） cm H2O vs（16.8±1.8） cm H2O

关 键 词：肺叶隔离 支气管堵塞导管 单肺通气 双腔支气管导管 肺顺应性 吸气峰压 

分 类 号：R614[医药卫生—麻醉学]