支气管封堵器在1~7岁儿童单肺通气胸腔镜手术中的应用效果及对肺萎陷的影响  

Application effect of bronchial blocker in children aged 1-7 years old with thoracoscopic surgery in one-lung ventilation and its influence on lung collapse

作　　者：耿秋雨 高静 金自瑛[1] GENG Qiu-Yu;GAO Jing;JIN Zi-Ying(Department of Anesthesiology,Children's Hospital Affliated to Zhejiang University Medical College,Hangzhou,Zhejiang 310000,China)

机构地区：[1]浙江大学医学院附属儿童医院麻醉科,浙江杭州310000

出　　处：《中国妇幼保健》2022年第15期2786-2791,共6页Maternal and Child Health Care of China

基　　金：国家自然科学基金资助项目(81901937)。

摘　　要：目的 探讨气管导管放置封堵器应用于1~7岁儿童单肺通气(OLV)胸腔镜手术中的效果及对肺萎陷的影响。方法 选取2018年10月—2020年4月在浙江大学医学院附属儿童医院接受OLV下胸腔镜手术的1~7岁患儿82例,随机分为观察组与对照组,各41例。观察组通过气管导管放置封堵支气管插管实现OLV,对照组通过气管导管置入实现OLV。对比两组手术情况及肺萎陷效果,分别统计OLV前(T0)、OLV后20 min(T1)、OLV后40 min(T2)及OLV后60 min(T3)心率(HR)、平均动脉压(MAP)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血氧饱和度(SpO)和气道压(Paw)。结果 观察组一次性插管成功率及肺萎陷优良率均为100.00%,显著高于对照组的85.37%、90.24%,差异均有统计学意义(P<0.05);观察组的插管时间、肺萎陷时间及手术时间明显短于对照组(P<0.05);观察组术中导管移位率为4.88%,显著低于对照组的17.07%(P<0.05);两组OLV时间及麻醉苏醒时间比较,差异无统计学意义(P>0.05)。两组不同时间点HR、MAP及SpO比较,差异均无统计学意义(均P>0.05);T1~T3时,观察组的PaO_(2)显著高于对照组,而PaCO_(2)、Paw显著低于对照组(P<0.05)。两组术后早期声嘶及咽喉疼痛发生率比较,差异无统计学意义(P>0.05)。结论 在小儿OLV胸腔镜手术中应用气管导管放置封堵支气管插管安全有效,较常规气管导管置入操作简便、成功率高且并发症少,能够加速肺萎陷并提高肺萎陷质量,为手术提供更理想的OLV和双肺隔离效果。Objective To explore the efficacy of bronchial blocker in children aged 1-7 years old with thoracoscopic surgery in one-lung ventilation(OLV) and its influence on lung collapse.Methods From October 2018 to April 2020,82 cases of children aged 1-7 years old who underwent thoracoscope surgery under OLV in Children’s Hospital Affiliated to Zhejiang University Medical College were randomly divided into observation group and control group, with 41 cases in each group.Observation group achieved OLV with bronchial blocker and tracheal catheter, control group achieved OLV with tracheal catheter.The surgical conditions and the effects of lung collapse in the two groups were compared, the heart rate(HR),mean arterial pressure(MAP),arterial blood oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),blood oxygen saturation(SpO) and airway pressure(Paw) before OLV(T0),20 min after OLV(T1),40 min after OLV(T2),60 min after OLV(T3) were counted respectively.Results The success rate of one-time intubation and the excellent rate of lung collapse in the observation group were 100%,which was significantly higher than 85.37% and 90.24% in the control group(P<0.05).The intubation time, lung collapse time, and operation time in the observation group were significantly shorter than those in the control group(P<0.05).The intraoperative catheter displacement rate was 4.88%,which was significantly lower than 17.07% in the control group(P<0.05).There was no significant difference in HR,MAP and SpObetween the two groups at different time points(P>0.05);from T1 to T3,the PaO_(2) in the observation group was significantly higher than the control group, while PaCO_(2) and Paw were significantly lower(P<0.05).There was no significant difference in the incidence of early hoarseness and throat pain between the two groups(P>0.05).Conclusion The bronchial blocker used in OLV for children aged 1-7 years old with thoracoscopic surgery is safe and effective, which has an advantages in terms of the placement, success rate, and t

关 键 词：胸腔镜手术 单肺通气 儿童 支气管封堵导管 肺萎陷 

分 类 号：R614.2[医药卫生—麻醉学]