双次呼吸暂停法对支气管封堵导管用于单肺通气时肺萎陷的影响  

Effect of double-apnea technique on lung deflation in one-lung ventilation with the bronchial blocker

作　　者：吴一霄[1] 刘荣君 徐芳 杨婧 陈骏萍[1] WU Yixiao;LIU Rongjun;XU Fang(Department of Anesthesiology,Ningbo Second Hospital,Ningbo 315010,China)

机构地区：[1]宁波市第二医院麻醉科,315010 [2]宁波大学医学院

出　　处：《浙江医学》2018年第23期2557-2560,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划一般项目(2017KY591;2017KY137;2018KY157);宁波市自然科学基金(2016A610144)

摘　　要：目的观察双次呼吸暂停法对支气管封堵导管(BB)用于单肺通气(OLV)时肺萎陷的影响。方法将择期行胸腔镜下单侧肺大泡修补术患者60例按随机数字表法分为呼吸暂停组(D组)、双次呼吸暂停组(B组)和持续负压吸引组(S组),每组20例。D组于OLV前,BB导管气囊抽气并暂停呼吸60s;B组于OLV前和胸膜打开即刻,行两次呼吸暂停,方法同D组。S组以-30cm H2O压力行持续负压吸引。记录OLV开始后3、6和9min时的肺萎陷质量评分;开始OLV至胸膜打开所消耗的时间;开始OLV至完全肺萎陷所消耗的时间。记录术中发生低氧血症及BB导管移位的例数。结果 OLV开始3min时,B组肺萎陷评分高于D组(P<0.05),S组低于D组和B组(P<0.05或0.01);6、9min时,B组和S组均高于D组(P<0.05或0.01),S组和B组间差异无统计学意义(P>0.05)。3组患者从开始OLV到胸膜打开所消耗的时间无统计学差异(P>0.05)。从开始OLV到完全肺萎陷所消耗的时间,B组和S组均少于D组(P<0.05或0.01);B组和S组之间无统计学差异(P>0.05)。3组患者的低氧血症、使用持续正压通气及导管移位的发生率均无统计学差异(均P>0.05)。结论 BB导管应用于OLV时,双次呼吸暂停法与持续负压吸引法在改善肺萎陷质量和加速肺萎陷方面效果相当,且均优于单次呼吸暂停法。Objective To explore the effect of double-apnea technique on lung deflation in one-lung ventilation(OLV)with the bronchial blocker(BB). Methods Sixty patients of ASA I or II grade aged 16-65with spontaneous pneumothorax scheduled for elective video-assisted surgery(VATS)from September 2016 to August 2017 at Ningbo Second Hospital were randomly assigned to group D,B and S.For lung deflation,group D received a apnea for 60 s prior to inflation of the BB;group B was given apnea twice prior to inflation of the BB and after the pleural incision;group S received negative pressure suction.The lung collapse(3,6 and 9 min following OLV)was rated;the time to total lung collapse and the time required for pleural opening were recorded.The number of hypoxaemia or need for continuous positive airway pressure(CPAP)during OLV and BB malposition was recorded as well. Results At 3 min after OLV,the surgeon rating of lung collapse in group B was higher than that in group D(P<0.05),and in group S was lower than that in group D(P<0.05)and B(P<0.001).At 6 min after OLV,the quality of lung collapse in group B(P<0.05)and S(P<0.01)were higher than that in group D;and there was no significant difference between groups S and B(P>0.05).At 9 min after OLV,the surgeon rating of lung collapse in group B(P<0.01)and S(P<0.05)were both higher than that in group D;and there was no significant difference between groups S and B(P>0.05).Compare to group D,the time need to obtain total lung collapse in group B and S was both shorter,and no significant difference was found between groups B and S(P>0.05).There was no significant changes in the time required for pleural opening(P>0.05).The incidence of hypoxaemia or need for CPAP during OLV and BB malposition has no significant difference among three groups(P>0.05). Conclusion Double-apnea technique improves lung deflation in one-lung ventilation with the bronchial blocker,the effect of which is equal to continuous bronchial suction and better than single-apnea technique.

关 键 词：双次呼吸暂停 肺萎陷 支气管封堵导管 单肺通气 

分 类 号：R614[医药卫生—麻醉学]