肺部超声在支气管封堵单肺通气中对判断肺隔离的影响  

Effect of pulmonary ultrasound on judging pulmonary isolation in one lung ventilation with bronchial occlusion

作　　者：杜宪 高艳平[1] 朱宏岩 乔世刚 王琛[2] DU Xian;GAO Yanping;ZHU Hongyan;QIAO Shigang;WANG Chen(Department of Anesthesiology,Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang 215600,China)

机构地区：[1]苏州大学附属张家港医院麻醉科,江苏省张家港市215600 [2]南京医科大学附属苏州科技城医院麻醉及围术期医学科

出　　处：《临床麻醉学杂志》2020年第11期1063-1067,共5页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(81801109)。

摘　　要：目的探讨肺部超声在支气管封堵单肺通气中判断肺隔离的效果。方法选取全身麻醉下左支气管封堵单肺通气下行左肺癌根治术的患者60例,年龄46~68岁,BMI 18~26 kg/m^2,ASAⅠ或Ⅱ级。采用随机数字法将患者分为三组:听诊组(A组)、纤维支气管镜组(F组)和超声组(U组),每组20例。置入支气管封堵导管后,A组采用听诊器听诊呼吸音,F组采用纤维支气管镜观察套囊位置,U组采用超声观察肺部超声影像判断肺隔离。观察三种方法判断肺隔离时间、肺萎陷满意度和术中封堵导管套囊位置的调整次数,观察三组诱导前(T 0)、诱导后(T 1)、定位时(T 2)、单肺通气时(T 3)、单肺通气30 min(T 4)时的HR、MAP、CVP。结果与A组比较,F组和U组判断肺隔离时间明显缩短(P<0.05或P<0.01),肺萎陷满意度明显升高(P<0.01或P<0.001),术中封堵导管套囊位置的调整次数明显降低(P<0.001)。F组和U组判断肺隔离效果时间、肺萎陷满意度、术中封堵导管套囊位置的调整次数差异无统计学意义。与T 0时比较,T 2时F组HR明显增快、MAP明显升高(P<0.05),与A组和U组比较,T 2时F组HR明显增快、MAP明显升高(P<0.01或P<0.001)。结论肺部超声用于判断单肺通气肺隔离效果优于听诊法,其判断效果与纤维支气管镜检查相近,且超声对于血流动力学的影响较纤维支气管镜小。Objective To explore the effect of pulmonary ultrasound in the diagnosis of pulmonary isolation in bronchial blocking one-lung ventilation.Methods Sixty patients with left lung cancer undergoing radical operation with general anesthesia were selected,aged 46-68 years,BMI 18-26 kg/m^2,ASA physical statusⅠorⅡ.The patients were randomly divided into auscultation group(group A),fibro bronchoscopy group(group F)and ultrasound group(group U).Each group had 20 patients.After inserting the bronchial blocking catheter,a stethoscope was used to auscultate breath sounds in group A,fiberoptic bronchoscopy was used to observe the position of the cuff in group F,and the lung ultrasound image was observed by ultrasonic in group U to determine lung isolation.Time needed for determine pulmonary isolation,satisfaction degree of pulmonary collapse and adjustment times of the position of the occlude cuff during the operation were observed and compared among the three methods.At the same time,the HR,MAP and CVP changes before induction(T 0),after induction(T 1),at location(T 2),at one lung ventilation(T 3)and at 30 min of one lung ventilation(T 4)were observed and compared.Results The time to judge the effect of pulmonary isolation in group F and group U was significantly shorter than that in group A(P<0.05 or P<0.01);the satisfaction in group F and group U with pulmonary collapse was higher than that in group A(P<0.01 or P<0.001);the adjustment times of cuff position in group F and group U were lower than that in group A,and there was no significant difference between group F and group U.Compared with T 0,HR and MAP at T 2 in group F were significantly higher(P<0.05).HR and MAP at T 2 in group F were significantly higher than those in group A and group U(P<0.01 or P<0.001).Conclusion pulmonary ultrasound is better than stethoscope in judging pulmonary isolation of one lung ventilation,and its effect is similar to fiber bronchoscope,and the effect of ultrasound on hemodynamics is smaller than fiber bronchoscope.

关 键 词：肺通气 听诊 支气管镜 支气管封堵导管 超声 

分 类 号：R614[医药卫生—麻醉学]