新型左主支气管阻塞器在食管癌术中单肺通气的应用研究  

Application of a new type left-bronchial-blocker for one-lung ventilation in esophageal cancer surgery

作　　者：赵清军 杨文锋[1,3] 商烁[2] 

机构地区：[1]济南大学山东省医学科学院医学与生命科学学院,济南250021 [2]章丘市人民医院 [3]山东省肿瘤医院

出　　处：《山东医药》2014年第9期31-33,共3页Shandong Medical Journal

基　　金：济南市科技计划项目;科研基金资助项目(201201050)

摘　　要：目的探讨新型左主支气管阻塞器（NTLBB）在食管癌术中单肺通气的应用价值。方法选择ASAⅠ-Ⅱ级限期手术治疗的食管癌患者30例,在麻醉诱导后,置入NTLBB实现右侧肺通气、左侧肺萎陷,便于手术操作及减轻肺损伤。通过观察导管置入定位一次成功率、单肺通气期间气道峰压（PEAK）和通气量（VT）、呼吸频率（R）、呼气末二氧化碳分压（ETCO2）、经皮血氧饱和度（SpO2）的变化、气道损伤程度、术后咽痛和声音嘶哑发生率,分析其在手术操作及减轻肺损伤中的作用。结果导管置入定位一次成功率为96.7%,侧卧位后经纤维支气管镜检查发现有6例（20%）支气管套囊位置需调整;与双肺通气相比,单肺通气期间PEAK稍升高,VT、R、ETCO2、SpO2变化不明显（P均〉0.05）;气道损伤程度评分为1.42分;术后咽痛发生率40%,声音嘶哑（伴随咽痛）发生率10%。结论NTLBB用于单肺通气,具有置入定位简单、阻隔效果确切、气道损伤小、术后并发症低等优点,有助于提高食管癌患者的手术及麻醉质量。Objective To investigate the clinical value of applying a new type left-bronchial-blocker（ NTLBB） for one-lung ventilation（ OLV） during the esophageal cancer surgery.Methods Thirty patients with esophageal cancer（ ASAⅠ-Ⅱ） were embedded the new type left-bronchial-blocker in order to achieve the right single lung ventilation and the left side collapse after anesthesia induction and thus to operate and reduce the lung injury.By observing the positioning catheterization success rate,peak airway pressure（ PEAK） during OLV,ventilation（ VT）,respiratory frequency（ R）,breath out CO2 partial pressure（ ETCO2）,the change of the SpO2,damage degree of the airway and the incidence of postoperative sore throat and hoarse,we analyzed the effect of NTLBB during the surgery and reducing the lung injuries.Results The positioning catheterization success rate was 96.7%,and 6 patients needed adjusting position of bronchial tampon which were observed by lateral position FOB examination（ 20%）.Compared with double lung ventilation,during OLV,PEAK was increased,but the changes of VT,R,ETCO2,SpO2 were not obvious（ all P〉 0.05）.Airway trauma score was 1.42.The incidence of postoperative follow-up hoarse（ accompanied by sore throat） was 10%,and the incidence of sore throat was 40%.Conclusions NTLBB for OLV has the advantages of simple,precise positioning,small airway lesions and low complications,and helps to improve the quality of esophageal cancer surgery and anesthesia.

关 键 词：食管肿瘤 单肺通气 新型左主支气管阻塞器 气道峰压 

分 类 号：R735.1[医药卫生—肿瘤]