反向握持式置管方法对行左侧可视双腔支气管导管置入术患者血流动力学的影响  

Effect of reverse holding catheterization on hemodynamics in patients undergoing left-sided video double-lumen bronchial catheterization

作　　者：刘冰涵 张伟 李陈茜 丛旭晖 郝欣蕊 张加强 LIU Bing-han;ZHANG Wei;LI Chen-xi;CONG Xu-hui;HAO Xin-rui;ZHANG Jia-qiang(Department of Anesthesiology and Perioperative Medicine,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院麻醉与围术期医学科,河南郑州150003

出　　处：《中华实用诊断与治疗杂志》2022年第4期390-393,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划项目(SB201901090)。

摘　　要：目的探讨反向握持式置管对行左侧可视双腔支气管导管(video double-lumen bronchial tube,VDLT)置入术患者置管时间、血流动力学和术后并发症的影响。方法行胸腔镜下右肺叶切除术患者90例,均行左侧VDLT置入,根据置管握持手法分为执笔组30例,正向组30例,反向组30例。比较3组患者体质量指数、ASA分级、双腔管型号、手术时间、首次置管成功率、置管时间、定位时间等临床资料,比较3组麻醉诱导前(T_(0))、置管前即刻(T_(1))、置管后即刻(T_(2))心率、收缩压、舒张压、平均动脉压及术后48 h时咽喉疼痛、声音嘶哑发生情况。结果反向组置管时间[4.0(2.8,6.0)s]短于执笔组[8.0(6.0,12.0)s]、正向组[9.0(7.0,12.0)s](P<0.05),执笔组与正向组比较差异无统计学意义(P>0.05);3组年龄、性别比例、体质量指数、ASA分级、双腔管型号、手术时间、首次置管成功率、定位时间比较差异均无统计学意义(P>0.05)。3组T_(2)时心率、收缩压、舒张压、平均动脉压均高于T_(0)、T_(1)时(P<0.05),3组T_(1)时收缩压、舒张压、平均动脉压均低于T_(0)时(P<0.05),心率与T_(0)时比较差异无统计学意义(P>0.05);T_(2)时反向组心率、收缩压、舒张压、平均动脉压均低于执笔组、正向组(P<0.05),执笔组与正向组比较差异无统计学意义(P>0.05);T_(0)、T_(1)时3组心率、收缩压、舒张压、平均动脉压比较差异均无统计学意义(P>0.05)。术后48 h时,反向组咽喉疼痛发生率(6.7%)低于执笔组(33.3%)、正向组(30.0%)(χ^(2)=6.667,P=0.010;χ^(2)=5.455,P=0.020),执笔组与正向组比较差异无统计学意义(χ^(2)=0.077,P=0.781)。反向组、执笔组、正向组声音嘶哑发生率(6.7%、10.0%、3.3%)比较差异无统计学意义(χ^(2)=1.102,P=0.868)。结论反向握持式置管行左侧VDLT置入术较传统执笔式和正向握持式置管时间短,血流动力学波动小,术后咽喉疼痛发生率低。Objective To investigate the influences of reverse holding catheterization on catheterization time,hemodynamics and postoperative complications in patients undergoing left-sided video double-lumen bronchial tube(VDLT)implantation.Methods Ninety patients scheduled for thoracoscopic right lobectomy underwent left-sided VDLT implantation.According to the catheterization method,90 patients were divided into writing group(n=30),forward group(n=30)and reverse group(n=30).The body mass index,ASA grade,double-lumen tube model,operation lasting time,success rate of the first catheterization,catheterization time,positioning time and other clinical data were compared among three groups.The heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure,sore throat and hoarseness at 48 h after operation were compared before anesthesia induction(T_(0)),immediately before catheterization(T_(1))and immediately after catheterization(T_(2))among three groups.Results The catheterization time was shorter in reverse group[4.0(2.8,6.0)s]than that in writing group[8.0(6.0,12.0)s]and forward group[9.0(7.0,12.0)s](P<0.05),and showed no significant difference between writing group and forward group(P>0.05).There were no significant differences in the age,gender ratio,body mass index,ASA grade,double-lumen tube model,operation lasting time,success rate of the first catheterization and positioning time among three groups(P>0.05).In three groups,the heart rate,systolic blood pressure,diastolic blood pressure and mean arterial pressure were higher at T_(2) than those at T_(0) and T_(1)(P<0.05),the systolic blood pressure,diastolic blood pressure and mean arterial pressure were lower at T_(1) than those at T_(0)(P<0.05),and the heart rate showed no significant difference at T_(1) compared with that at T_(0)(P>0.05).At T_(2),the heart rate,systolic blood pressure,diastolic blood pressure and mean arterial pressure were lower in reverse group than those in writing group and forward group(P<0.05),and showed no significant diff

关 键 词：可视双腔支气管导管 胸科手术 置管手法 反向握持式 

分 类 号：R614[医药卫生—麻醉学]