I-Gel喉罩联合气管导管和支气管封堵器在食管癌根治术单肺通气中的应用  

The application of I-Gel laryngeal mask combined with endotracheal tube and bronchial blocker in esophageal cancer radical prostatectomy for onedung ventilation

作　　者：王瑞明[1] 程波[2] 柴小青[1] 

机构地区：[1]安徽省立医院麻醉科,合肥230001 [2]山东省胸科医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2015年第7期623-626,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨Ⅰ-Gel喉罩联合气管导管和支气管封堵器在食管癌根治术单肺通气的可行性和效果。方法择期行食管癌根治手术患者60例，年龄40岁～80岁，美国麻醉医师协会（ASA）分级Ⅰ～Ⅲ级，采用随机数字表法分为3组（每组20例）：双腔支气管导管组（D组）、单腔气管导管联合支气管封堵器组（B组）、Ⅰ-Gel喉罩联合气管导管和支气管封堵器组（Ⅰ组）。记录各组支气管封堵器或双腔支气管导管的定位时间、术中支气管封堵器或双腔支气管导管移位的次数、肺萎陷的程度及单肺通气的气道峰压，记录诱导前（T0）、气管插管或喉罩置入前（T1）、气管插管或喉罩置入后1min（T2）、气管插管或喉罩置入后5min（T3）、术后气管导管或喉罩拔除前5min（T4）、拔管或喉罩拔除后1min（T5）、拔管或喉罩拔除后5min（T6）患者的血压、心率及拔管或喉罩期间的呛咳例数，记录术后2d内患者咽痛、声音嘶哑等副作用。结果Ⅰ组除T1时收缩压（117±9）mmHg（1mmHg=0．133kPa）和舒张压（65±9）mmHg低于术前收缩压（145±12）mmHg和舒张压（75±9）mmHg（P〈0．05）外，诱导期间及术后恢复期各时点患者血压与术前比较差异无统计学意义（P〈0．05），B组和D组麻醉插管后及术后恢复期T2～T6时患者心率及血压高于术前（P〈0．05）；Ⅰ组（0例）拔管期间呛咳反应少于B组（8例）和D组（15例）（P〈0．05）；Ⅰ组（0例）术后咽痛和声嘶的发生例数低于D组（16例）、B组（7例）（P〈0．05）。Ⅰ组定位时间（4．2±1．2）min长于B组（2．8±0．7）min和D组（2．7±0．4）min（P〈0．05），D组、B组和Ⅰ组术中移位例数及肺萎陷程度相似（P》0．05），Ⅰ组[（22±3）mmHg]和B组[（21±4）mmHg]单肺通气期间气道峰压力低于于D组[（28±4）mmHg]（P〈0．05），而Ⅰ组和B组气道峰压差异无统计学意义（PObjective To evaluate the efficacy of I-Gel laryngeal mask combined with endotracheal tube/bronchial blocker in patients undergoing esophageal cancer radical prostatectomy for one-lung ventilation. Methods Sixty patients aged 40 to 80 years old, ASA Ⅰ -Ⅲ, undergoing selective esophageal cancer radical surgery, were randomly divided into three groups （n=30）： double -lumen tube group （D group）, endotraeheal tube with bronchial blocker group （B group）, I-Gel laryngeal mask with endotracheal tube and bronchial blocker （I group）. The variables were recorded including the time required to achieve the optimal positioning of the device, efficiency of lung collapse and perioperative malposition frequency of double -lumen tubes/bronchial blockers and the airway pressure during one-lung ventilation. The blood pressure and heart rate were recorded before anesthesia, immediately before induction, 1 minute and 5 min after intubation, 5 min before extubation and 1, 5 min after extubation（T0-6）. The complications of bucking during extubation and pharyngalgia and hoarseness in two days after the surgery were recorded. Results No obvious fluctuation of blood pressure and heart rate were seen in the I group during the period of induction and extubation except the time of T1 [systolic blood pressure： （117±9） mmHg vs （145±12） mmHg, diastolic blood pressure： （65±9） mmHg vs （75±9） mmHg （P〈0.05）（1mmHg=0.133 kPa）]. Blood pressure and heart rate at the time of T2-6 in the D group and the B group were high than the baseline （T0）. The bucking frequency during extubationand pharyngalgia/hoarseness in two days after the surgery in B group and the D group were higher than in the I group （0 vs 8 vs 15, P〈0.05）（0 vs 16 vs 7, P〈0.05）. The positioning time of I group was longer than B group and D group＇s（4.2±1.2） rain vs （2.8±0.7） min vs （2.7±0.4） min（P〈0.05）. There were no significant difference in efficiency of lung collapse and perioperative malpo

关 键 词：I-Gel喉罩 气管导管 支气管封堵器 食管癌根治术 单肺通气 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]