组合式支气管导管在成年人胸科手术单肺通气中的应用  

Application of combined bronchial tube on one⁃lung ventilation in adult patients undergoing thoracic surgery

作　　者：贺争光 陈溪 刘大为 孙晨旭 冯飚 徐霞 朱和子 孙志华[2] He Zhengguang;Chen Xi;Liu Dawei;Sun Chenxu;Feng Biao;Xu Xia;Zhu Hezi;Sun Zhihua(Department of Anesthesiology,Xiangya Changde Hospital,Changde 415000,China;Department of Anesthesiology,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]湘雅常德医院麻醉科,常德415000 [2]中南大学湘雅医院麻醉科,长沙410008

出　　处：《国际麻醉学与复苏杂志》2022年第5期485-489,共5页International Journal of Anesthesiology and Resuscitation

基　　金：常德市科技局科技创新发展项目(2020S114)。

摘　　要：目的评价组合式支气管导管在成年人胸科手术单肺通气(one‑lung ventilation,OLV)中应用的可行性与优势。方法选取拟行OLV的成年胸科手术患者60例,随机数字表法分为2组(每组30例):双腔支气管导管(double lumen endobronchial tube,DLT)组(D组)和组合式支气管导管组(C组)。所有患者按统一标准实施全身麻醉诱导,D组插入DLT,C组插入组合式支气管导管。术中麻醉维持采用相同方案,术毕D组待患者苏醒后拔除DLT,C组在停止OLV后即拔除内气管导管,患者苏醒后拔除外气管导管。记录两组患者麻醉前(T_(0))、插管前(T_(1))、插管完成后1 min(T_(2))、插管完成后5 min(T_(3))、拔管前(T_(4))、拔管后1 min(T_(5))、拔管后5 min(T_(6))的MAP、心率,记录两组纤维支气管镜(纤支镜)下调整定位情况、插管对位时间、单/双肺通气时气道压、单/双肺通气过程中最低SpO_(2),术中记录肺萎陷效果,术后记录口咽部和气道损伤情况,术后24 h随访气道相关不良事件发生情况。结果T_(2)、T_(4)、T_(5)时点,D组MAP、心率均高于C组(P<0.05);两组单/双肺通气时气道压、单/双肺通气过程中最低SpO_(2)、肺萎陷效果、口咽部及气道损伤发生率比较,差异无统计学意义(P>0.05);C组插管对位时间短、纤支镜下调整定位率低,且术后气道相关不良事件的发生率低于D组(P<0.05)。结论组合式支气管导管是一种可以在成年人胸科手术中实现OLV的新型导管,相对于DLT,其对患者循环波动影响小、插管对位难度低、术后气道相关不良事件发生少。Objective To evaluate the feasibility and advantages of combined bronchial tube in one‑lung ventilation(OLV)in adult patients undergoing thoracic surgery.Methods A total of 60 adult patients who were scheduled for thoracic surgery with OLV were divided into two groups,according to the random number table method(n=30):a double lumen endobronchial tube(DLT)group(group D)and a combined bronchial tube group(group C).All patients underwent anesthesia induction according to the unified stan‑dard.After induction,patients in group D were inserted with DLT,while those in group C were inserted with combined bronchial tube.Their anesthesia maintenance followed the same regimen.After the end of the operation,patients in group D were resuscitated and the DLT was removed.For group C,the endotracheal tube was removed after OLV,while the external tracheal tube was removed after resus‑citation.Then,their mean arterial pressure(MAP)and heart rate before anesthesia(T_(0)),before intubation(T_(1)),1 min(T_(2))and 5 min(T_(3))after intubation,before extubation(T_(4)),1 min(T_(5))and 5 min(T_(6))after extubation were recorded.Furthermore,position changes under a fiberoptic bronchoscope,the time from intubation to alignment,airway pressure and the minimum pulse oxygen saturation(SpO_(2))during one‑lung/double lung ventilation were recorded.The results of lung collapse,injury of oral cavity or airway,and airway related adverse events within postoperative 24 h were recorded.Results MAP and heart rate in group D were higher than those in group C at T_(2),T_(4) and T_(5)(P<0.05).There was no statistical difference in airway pressure and the minimum SpO_(2) during one‑lung/double lung ventilation,lung collapse and the incidence of oral cavity and airway injury between the two groups(P>0.05).The percentage of position change un‑der a fiberoptic bronchoscope,the time from intubation to alignment,and the incidence of postoperative airway related adverse events in group C were lower than those in group D(P<0.05).Conclusions Combined

关 键 词：组合式支气管导管 双腔支气管导管 单肺通气 

分 类 号：R614[医药卫生—麻醉学]