胸腔镜下房颤射频消融术中不同肺隔离措施的临床效果  

Effect of different one-lung ventilation strategies on vedio-assisted atrial fibrillation ablation

作　　者：李炎[1] 龚婵娟[1] 陈晓东[1] 陈宇[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2017年第2期121-124,共4页Journal of Clinical Anesthesiology

基　　金：基金项目:江苏省六大高峰人才(指导性2013-WSW-018)

摘　　要：目的比较左侧型双腔导管与支气管封堵器在胸腔镜下房颤射频消融术中的临床效果和安全性。方法选择拟行全麻下射频消融术的房颤患者48例,男26例,女22例,年龄45~65岁,ASAⅠ或Ⅱ级,随机分为双腔导管组(A组)和支气管封堵器组(B组),每组24例。记录插管前、定位准确即刻的MAP和HR;记录两组插管时间和单肺通气5min时的气道峰压(Ppeak);评估肺萎陷及手术视野暴露效果;记录拔管呛咳、声音嘶哑和咽喉痛等不良反应的发生情况。结果两组插管时间差异无统计学意义;与插管前比较,定位准确即刻两组MAP明显升高,HR明显加快,且A组明显高于和快于B组(P<0.05)。左侧单肺通气时,A组Ppeak明显高于B组(P<0.05),右上肺萎陷效果明显优于B组(P<0.05);右侧单肺通气时,两组Ppeak差异无统计学意义。A组拔管呛咳、声音嘶哑和咽喉痛发生率明显高于B组(P<0.05)。结论左侧型双腔导管与支气管封堵器均能满足胸腔镜下房颤射频消融术的手术需求,左侧型双腔导管肺隔离效果优于支气管封堵器,但其引起的插管应激反应更重,拔管呛咳、声音嘶哑和咽喉痛的发生率更高。Objective To compare clinical effect and safety of left-double-lumen tube and bronchial blocker in vedio-assisted atrial fibrillation ablation.Methods Forty-eight patients,26 males and 22 females,aged 45-65 years,ASA physical statusⅠ orⅡ,who underwent vedio-assisted atrial fibrillation ablation were randomly divided into double-lumen tube（group A）and bronchial blocker（group B）,with 24 patients in each group.The tube type of group A was left-double-lumen tube.Bronchofiberscope was used for location in every patient.The mean artery pressure（MAP）and heart rate（HR）before intubation,intubation positioning time,peak airway pressure（Ppeak）after 5min of one-lung ventilation,lung collapse,incidences of hoarseness,pharyngalgia and choke were observed.Results Intubation positioning time between two groups was not statistically significant.MAP and HR were significantly increased at intubation positioning time in both groups,to be specific,they were significantly in group A than in group B（P〈0.05）.When left lungs blocked,Ppeak and qualities of lung collapse were not statistically different between the two groups.When right lungs blocked,group A was higher than that in group B（P〈0.05）.Cough,hoarseness and sore throat were more frequently seen in group A than in group B.Conclusion Both double-lumen tube and bronchial blocker can be used in video-assisted atrial fibrillation ablation with satisfying effects.As for the quality of lung isolation,double-lumen tube was better than bronchial blocker.However,compared with bronchial blocker,double-lumen tube results in more unstable hemodynamics and higher occurrence of hoarseness,pharyngalgia and choke.

关 键 词：单肺通气 房颤射频消融 双腔气管导管 支气管封堵器 

分 类 号：R614[医药卫生—麻醉学]