双腔支气管导管和支气管封堵器肺隔离在短暂停通气结合支气管腔阻塞技术单肺通气中应用效果  

Efficacy of lung isolation with double-lumen bronchial tube versus bronchial blocker on one-lung ventilation by using short apnea combined with internal channel occlusion technique

作　　者：李佳仪 张凌 万磊[1] 李文静 薛富善 LI Jiayi;ZHANG Ling;WAN Lei;LI Wenjing;XUE Fushan(Department of Anesthesiology,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉手术中心,北京100050

出　　处：《中华实用诊断与治疗杂志》2024年第8期803-809,共7页Journal of Chinese Practical Diagnosis and Therapy

基　　金：2022年北京市卫生健康科技成果和适宜技术立项项目(BHTPP2022081)。

摘　　要：目的比较双腔支气管导管(DLBT)与支气管封堵器(BB)肺隔离在应用短暂停通气结合术侧支气管腔阻塞(SAICO)技术实施单肺通气(OLV)管理中的效果和安全性。方法2022年1—12月首都医科大学附属北京友谊医院行择期肺部分切除术患者95例,均行视频辅助胸腔镜手术,随机分为DLBT组(肺隔离采用DLBT)47例和BB组(肺隔离采用BB)48例,2组均采用SAICO技术行OLV管理,观察2组肺完全塌陷时间、气管插管时间、肺隔离时间、及机械通气指标,记录麻醉诱导前(T_(1))、气管插管完成时(T_(2))、肺隔离工具定位完成时(T_(3))平均动脉压、心率及术后24 h咽痛、声音嘶哑发生情况。结果BB组肺完全塌陷时间[13(9,16)min]短于DLBT组[15(13,17)min](Z=-2.289,P=0.022),气管插管时间[62.0(42.0,77.0)s]、肺隔离时间[110.0(84.0,132.0)s]均长于DLBT组[32.0(30.5,43.0)、74.0(65.5,90.5)s](Z=-6.137,P<0.001;Z=-4.646,P<0.001),OLV时气道峰压[21(19,23)cmH_(2)O]低于DLBT组[23(21,24)cmH_(2)O](Z=-2.831,P=0.005),进胸即刻肺塌陷质量、肺隔离工具定位时间和移位情况,双肺通气时潮气量、气道峰压、气道平台压,OLV-进胸时间、OLV时间、OLV时潮气量、OLV时气道平台压及胸膜切开前、后低氧血症发生率与DLBT组比较差异均无统计学意义(P>0.05)。BB组T_(2)时平均动脉压[(103.7±6.4)mmHg]、心率[(78.0±10.6)次/min]及术后24 h轻中度咽痛和声音嘶哑发生率(62.5%、56.3%)均低于DLBT组[(111.7±6.5)mmHg、(87.9±9.6)次/min、80.8%、76.6%](t=-6.139、-4.652,χ^(2)=6.869、7.405;P均<0.05),T_(1)、T_(3)时平均动脉压、心率与DLBT组比较差异均无统计学意义(t=0.467、-0.813、0.371、-1.524,P均>0.05)。结论采用SAICO技术行OLV时,DLBT和BB肺隔离均可达到满意的术侧肺塌陷;与DLBT相比,BB所致气道操作相关血流动力学变化较小,OLV时气道峰压及术后咽痛和声音嘶哑发生率明显降低。Objective To compare the efficacies and safeties of double-lumen bronchial tube(DLBT)and bronchial blocker(BB)for lung isolation in one-lung ventilation(OLV)by using short apnea combined with internal channel occlusion(SAICO)technique.Methods Ninety-five patients were scheduled for video-assisted thoracoscopic surgery for partial lung resection in Beijing Friendship Hospital Affiliated to Capital Medical University from January to December2022,and were randomly divided into 47 patients receiving lung isolation with DLBT(DLBT group)and 48 patients receiving lung isolation with BB(BB group).The SAICO technique was used for OLV in both groups.The time for complete lung deflation,intubation time,lung isolation time,and mechanical ventilation parameters were observed.The mean artery pressures and heart rates before induction of anaesthesia(T_(1)),at tracheal intubation(T_(2))and at the end of correct device placement(T_(3)),and the incidences of sore throat and hoarseness 24 h postoperatively were observed in two groups.Results The time for complete lung deflation was shorter in BB group[13(9,16)min]than that in DLBT group[15(13,17)min](Z=-2.289,P=0.022).The intubation time and lung isolation time were longer in BB group[62.0(42.0,77.0),110.0(84.0,132.0)s]than those in DLBT group[32.0(30.5,43.0),74.0(65.5,90.5)s](Z=-6.137,P<0.001;Z=-4.646,P<0.001).The peak airway pressure during OLV was lower in BB group[21(19,23)cmH_(2)O]than that in DLBT group[23(21,24)cmH_(2)O](Z=-2.831,P=0.005).There were no significant differences in the quality of lung deflation immediately after pleurotomy,positioning time and malposition rate of studied devices,tidal volume,peak airway pressure and airway platform pressure during double-lung ventilation,time between OLV to pleurotomy,OLV duration,tidal volume during OLV,airway platform pressure,and incidence of hypoxemia before and after pleurotomy between two groups(P>0.05).The mean artery pressure and heart rate at T_(2),and the incidences of mild and moderate sore throat and hoarseness 24 h

关 键 词：单肺通气 视频辅助胸腔镜手术 双腔支气管导管 支气管封堵器 肺塌陷 

分 类 号：R614[医药卫生—麻醉学]