封堵支气管导管与双腔支气管导管在胸部外科手术患者中的应用效果比较  

Comparison of application effects of block bronchial catheter and double channel catheter in thoracic surgery patients

作　　者：杨国栋 白亚光 郭平 沈千贺 杨渊 YANG Guodong;BAI Yaguang;GUO Ping;SHEN Qianhe;YANG Yuan(Xi'an Gem Flower Changqing Hospital,Xi'an 710201,China)

机构地区：[1]西安宝石花长庆医院,陕西西安710201

出　　处：《临床医学研究与实践》2023年第14期38-41,共4页Clinical Research and Practice

摘　　要：目的比较封堵支气管导管与双腔支气管导管在胸部外科手术患者中的应用效果。方法选取2019年1月至2020年12月我院68例择期行胸部外科手术的患者,将其随机分为A组(35例)和B组(33例)。A组采用双腔支气管导管,B组采用封堵支气管导管。比较两组双肺通气5 min时(T1)、单肺通气30 min后(T2)和单肺通气60 min后(T3)的脉搏血氧饱和度(SpO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO_(2))、呼气末二氧化碳分压(PETCO_(2))、气道压力(Paw);评价两组肺泡萎陷及手术视野暴露情况;记录两组完成插管时间及不良事件发生情况、处理情况。结果T1~T3时,两组的SpO2、PaO2、PaCO_(2)、PETCO_(2)比较,差异无统计学意义(P>0.05);T1~T3时,A组的Paw高于B组,差异具有统计学意义(P<0.05);T2~T3时,两组的PaO2低于T1时,Paw高于T1时,差异具有统计学意义(P<0.05);两组各个时间点均未发生低氧血症。两组的肺泡萎陷及手术视野暴露优良率比较,差异无统计学意义(P>0.05);B组的完成插管时间短于A组,差异具有统计学意义(P<0.05)。A组有2例经纤维支气管镜检查证实双腔支气管导管套囊位置过浅,调整套囊位置后肺泡萎陷良好;B组有1例肺泡萎陷不佳,经纤维支气管镜检查证实封堵支气管导管套囊位置良好,考虑肺脏残余气体吸收及排出不佳,断开加强型气管导管与呼吸管路的连接,封堵支气管导管套囊放瘪,吸引器经封堵支气管导管吸引管开口充分吸引,待肺脏内残余气体排出及肺泡萎陷2 min后,封堵支气管导管套囊充气封堵,之后肺泡萎陷、手术术野暴露良好。结论封堵支气管导管可有效缩短完成插管时间,Paw更低,肺泡萎陷及手术视野暴露情况与双腔支气管导管无明显差异。Objective To compare the application effects of block bronchial catheter and double channel catheter in thoracic surgery patients.Methods A total of 68 patients who underwent elective thoracic surgery in our hospital from January 2019 to December 2020 were selected and randomly divided into group A(35 cases)and group B(33 cases).The group A used double channel catheter,and the group B used block bronchial catheter.The oxygen saturation(SpO2),partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),end-tidal carbon dioxide partial pressure(PETCO2)and airway pressure(Paw)at 5 min of double lung ventilation(T1),after 30 min of single lung ventilation(T2)and after 60 min of single lung ventilation(T3)were compared between the two groups;the alveolar collapse and surgical field exposure in the two groups were evaluated;the completion time of intubation and the occurrence and handling of adverse events in two groups groups were record.Results From T1 to T3,there were no statistically significant differences in SpO2,PaO2,PaCO2 and PETCO2 between the two groups(P>0.05);from T1 to T3,the Paw of the group A was higher than that of the group B,and the difference was statistically significant(P<0.05);from T2 to T3,PaO2 of the two groups was lower than that at T1,Paw was higher than that at T1,and the differences were statistically significant(P<0.05);hypoxemia did not occur at any time point in the two groups.There was no statistically significant difference in the excellent and good rate of alveolar collapse and surgical field exposure between the two groups(P>0.05);the completion time of intubation in the group B was shorter than that in the group A,and the difference was statistically significant(P<0.05).In the group A,2 cases were confirmed by fiber bronchoscopy examination that the position of double channel catheter cuff was too shallow,and the alveolar collapse was good after adjusting the cuff position;1 case in the group B had poor alveolar collapse,the fiber bronchoscopy examination confirmed that

关 键 词：封堵支气管导管 双腔支气管导管 单肺通气 动脉血氧分压 气道压力 

分 类 号：R614[医药卫生—麻醉学]