支气管封堵器选择性肺叶隔离在儿童肺包虫囊肿手术中的应用研究  

lobar isolation performed by bronchial blocker in Tibet children undergoing pulmonary hydatid cyst enucleation

作　　者：赤列 罗伟 边巴旺堆 巴桑仓木决 格桑罗布 Tinley;LUO Wei;Penpa Wandui;Palsan Tsocos;Kelsang Norbu(Department of Anesthesiology,Shigatse People’s Hospital,Shigatse 857000,Tibet,China)

机构地区：[1]西藏自治区日喀则市人民医院麻醉科,西藏日喀则857000 [2]上海交通大学医学院附属第九人民医院麻醉科

出　　处：《上海医学》2023年第4期220-224,共5页Shanghai Medical Journal

基　　金：西藏自治区自然科学基金[XZ2017ZRG-77(Z)]。

摘　　要：目的探讨支气管封堵器选择性肺叶膈离应用于西藏自治区儿童肺包虫囊肿手术时麻醉气道管理的安全性和可行性。方法选择2016年7月—2020年12月西藏自治区日喀则市人民医院择期行肺包虫囊肿内囊摘除术的患儿42例,采用随机数字表法分为封堵器组(22例)和双腔管组(20例)。两组分别通过支气管封堵器和双腔管插管行肺隔离通气。观察并记录肺隔离成功率、肺隔离期低氧干预率及氧合情况、术后早期并发症的发生率。比较患者在麻醉前(T_(0))、麻醉后肺隔离前(T_(1))、肺隔离后20 min(T_(2))、肺隔离后45 min(T_(3))及恢复双肺通气20 min(T_(4))的PaO_(2)和氧合指数(OI)。结果双腔管组2例因插管失败退出后续研究,3例因单肺通气发生顽固性低氧血症改行间断双肺通气完成手术。封堵器组肺隔离成功率显著高于双腔管组[100.0%(22/22)比75.0%(15/20),P<0.05)],肺隔离期间封堵器组低氧干预率显著低于双腔管组[4.5%(1/22)比8/18,P<0.05],封堵器组术后咽痛或声嘶的发生率显著低于双腔管组[9.1%(2/22)比9/18,P<0.05]。封堵器组插管时间显著长于双腔管组[(229.32±46.09)s比(192.56±28.87)s,P<0.05],通气峰压显著低于双腔管组[(19.59±4.07)mmHg比(24.17±3.62)mmHg(1 mmHg=0.133 kPa),P<0.05],封堵器组T_(2)、T_(3)时间点的PaO_(2)和OI显著高于双腔管组同时间(P值均<0.05);两组间肺萎陷优良率、术侧支气管引流评分、膨肺优良率,以及术后低氧合和肺不张发生率的差异均无统计学意义(P值均>0.05)。结论支气管封堵器选择性肺叶隔离可安全应用于儿童肺包虫囊肿摘除手术,其在我国高原地区低龄患儿中可能较双腔管单肺通气更具应用价值。Objective To explore the safety and feasibility of bronchial blocker used in one-lung ventilation during pulmonary hydatid cyst enucleation in Tibet children.Methods Forty-two children undergoing pulmonary hydatid cyst enucleation at Shigatse People’s Hospital from July 2016 to December 2020 were randomized into bronchial blocker group(22cases)and double lumen tube group(20cases).The intubation and airway operation,hypoxic intervention and oxygenation during lung isolation,and incidence of early postoperative complications were observed.The partial arterial oxygen pressure(PaO_(2))and oxygenation index(OI)before anesthesia(T_(0)),before lung isolation(T_(1)),20 min after isolation(T_(2)),45 min after isolation(T_(3))and 20 min after resumption of bilateral lung ventilation(T_(4))were compared between two groups.Results Two cases in the double lumen tube group withdrew from the follow-up study because of failed intubation,and three cases completed the procedure with intermittent double lung ventilation instead because of intractable hypoxemia on single-lung ventilation.The bronchial blocker group had higher success rate of lung isolation(100%[22/22]vs.75.0%[15/20]),lower intervention rate in hypoxemia(4.5%[1/22]vs.8/18),lower incidence of postoperative sore throat and/or hoarseness(9.1%[2/22]vs.9/18),longer time spent in intubation([229.32±46.09]s vs.[192.56±28.87]s),and lower peak airway pressure([19.59±4.07]mmHg vs.[24.17±3.62]mmHg[1 mmHg=0.133 kPa])than the double lumen tube group(all P<0.05).The PaO_(2)and OI at T_(2)and T_(3)in the bronchial blocker group were significantly higher than those in the double lumen tube group(all P<0.05).There were no significant differences in the incidences of pulmonary collapse,bronchial drainage,lung expansion,postoperative hypoxemia and atelectasis between two groups(all P>0.05).Conclusion The selective lobar isolation ventilation performed by bronchial blocker can be safely applied in the pulmonary hydatid cyst enucleation.Bronchial blocker may have more advantages th

关 键 词：支气管封堵器 选择性肺叶隔离 西藏儿童 肺包虫病 

分 类 号：R614[医药卫生—麻醉学]