出 处:《临床军医杂志》2016年第6期566-568,共3页Clinical Journal of Medical Officers
摘 要:目的探讨喉罩联合支气管阻塞器在达芬奇机器人手术系统(DVSS)行纵膈肿物切除术中的应用效果。方法选择沈阳军区总医院行DVSS纵膈肿物切除术患者24例随机分为两组,分别应用双腔支气管导管(V组,n=12)和喉罩联合Coopdech支气管封堵器(C组,n=12)。所有患者入室后连续监测有创血压。全麻诱导后,C组纤维支气管镜明视插入I-gel双管喉罩和Coopdech支气管阻塞器,切皮后置入戳卡,进胸前向支气管封堵器套囊内注入2~6 ml空气,行单肺通气(OLV)。V组患者选择双腔支气管导管行OLV。记录插管及定位时间、操作成功率及手术视野显露满意度;记录麻醉诱导后(T_0)、OLV后10 min(T_1)、OLV后30 min(T_2)、恢复双肺通气(TLV)10 min(T_3)共4个时间点患者的血氧饱和度(SpO_2)、呼气末二氧化碳分压(P_(ET)CO_2)及气道平台压(Pplat)、气道峰压(Ppeak);记录手术后声音嘶哑、咽喉疼痛等并发症的发生率。结果与V组比较,C组患者T_1和T_2时Pplat及Ppeak下降(P〈0.05);但两组间各时点SpO_2和P_(ET)CO_2比较,差异均无统计学意义(P〉0.05)。两组插管成功率和术中肺萎陷优良率比较,差异无统计学意义(P〉0.05);C组支气管封堵器插管及定位时间明显长于V组(P〈0.05)。C组术后咽喉痛的发生率较V组显着降低(P〈0.05)。结论采用喉罩联合支气管阻塞器配合DVSS纵膈肿瘤切除术,可完全无管化,患者恢复快,并发症少,是一项安全有效的新技术,患者满意度较高。Objective To evaluate the effective clinical application of laryngeal mask airway combined with Coopdech bronchial blocker tube in patients undergoing mediastinal tumor resection under da Vinci surgical system( DVSS). Methods Twenty-four patients undergoing mediastinal tumor resection under DVSS were randomly divided into double lumen endobronchial tube group( Group V,n =12) in which double lumen endobronchial tube was performed for one lung ventilation and laryngeal mask airway combined with Coopdech bronchial blocker tube group( Group C,n = 12) in which Coopdech endobronchial blocker tube were performed for the one lung ventilation( OLV). Group C received laryngeal mask airway and Coopdech bronchial blocker were inserted to the target bronchus after anesthesia and fixed under the help of a stethoscope. The intubation and positioning time,success rate,satisfaction degree of OLV and the complications after surgery were recorded. The peak airway pressure( Ppeak),platforms airway pressure( Pplat),SpO_2 and P_(ET)CO_2 were recorded at four times: after anesthesia( T_0),10 minutes after OLV( T_1),30 minutes after OLV( T_2) and 10 minutes BLV( T_3).Results Compared with Group V,Ppeakand Pplatat T_1,T_2 were decreased in group C( P〈0. 05). There were no significant differences in SpO_2 and P_(ET)CO_2 at four times between the two groups( P〉0. 05). The time of intubation and positioning in Group C was longer than that in Group V( P〈0. 05). There were no significant differences in success rate and satisfaction degree of OLV between the two groups( P〈0. 05). The rate of sore throat in Group C was lower than that in Group V( P〈0. 05). Conclusion Coopdech bronchial blocker combined with laryngeal mask airway applied for OLV in mediastinal tumor resection under DVSS is a new safely and effective method which is totally no tube,rapid recovery,the fewer complications and high patient's satisfaction.
关 键 词:喉罩 支气管封堵器 达芬奇机器人手术系统 纵膈肿物
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