体外循环下全胸腔镜二尖瓣手术两种单肺通气导管的比较研究  

Comparison of two different endotracheal tubes for one-lung ventilation during totally thoracoscopic mitral valve surgery on cardiopulmonary bypass

作　　者：张涛元 戚洋洋 雷翀[1] 董海龙[1] 张慧[1] 侯丽宏[1] 

机构地区：[1]中国人民解放军第四军医大学西京医院麻醉科,西安710032 [2]中国人民解放军第四军医大学研究生管理大队,西安710032

出　　处：《中国体外循环杂志》2017年第2期76-80,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金资助项目(81370011);第四军医大学课题资助项目(2016XD168)

摘　　要：目的比较体外循环下全胸腔镜二尖瓣手术中,双腔管与封堵管的有效性和副作用。方法共纳入并完成55例体外循环下全胸腔镜二尖瓣手术患者,完全随机分为双腔管组和封堵管组,分别比较两种气管导管的置入情况、插管期血流动力学、术中机械通气参数以及气道相关并发症发生率。结果封堵管的置入时间略长于双腔管,但封堵管引起的血流动力学波动更小,且二者的单肺通气质量无差别。气管黏膜损伤情况、术后声音嘶哑、喉痛等并发症发生率,封堵管组均明显低于双腔管组。结论封堵管和双腔管用于体外循环下全胸腔镜二尖瓣手术时均能实现良好的肺隔离,为手术提供理想的视野。封堵管的气道相关损伤更轻,更适于这种手术。Objective To compare the efficacy and adverse effects of bronchial blocker and double-lumen endobronchial tube used in totally thoracoseopic mitral valve surgery on cardiopulmonary bypass. Methods Fifty-five patients undergoing totally thoraeoscopic mitral valve surgery on cardiopulmonary bypass were included and randomly divided into double lumen endobronchial tube group （DLTs） or bronchial blocker group （BBs）. The efficiency of insertion of two different tubes and hemodynamics during intubation, intraoperative mechanical ventilation parameters and adverse complications of airway were compared. Results Although bronchial blocker tube placement in BBs took longer than double lumen endobronchial tube in DLTs, intubation of BBs had a more stable hemodynamics, and both groups had similar efficacy for one-lung ventilation. BBs were associated with significantly lower incidence of airway mucous injury, postoperative sore throat and hoarseness than DLTs. Conclusions Although bronchial blockers and double-lumen endohronchial tubes can both achieve good lung isolation and provide ideal operation conditions during totally thoracoscopic mitral valve surgery, bronchial blocker is preferred for these operations due to reduced airway complications.

关 键 词：单肺通气 双腔支气管导管 支气管封堵器 全胸腔镜 二尖瓣手术 体外循环 

分 类 号：R614[医药卫生—麻醉学]