喉罩联合支气管封堵器对胸腔镜手术中肺通气的影响  

Effect of laryngeal mask airway combined with bronchial blocker on pulmonary ventilation in thoracoscopic surgery

作　　者：李义 高冬艳[1] 张煜东[1] 李攀[1] LI Yi;GAO Dongyan;ZHANG Yudong;LI Pan(Department of Anesthesiology,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院麻醉科,石家庄市050051

出　　处：《临床麻醉学杂志》2025年第2期159-164,共6页Journal of Clinical Anesthesiology

摘　　要：目的评价喉罩联合支气管封堵器用于胸腔镜肺结节切除术中肺通气的效果。方法选择择期全麻下胸腔镜肺结节切除术患者140例,男55例,女85例,年龄18~75岁,BMI<30 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:气管插管联合支气管封堵器组(E组)和喉罩联合支气管封堵器组(L组),每组70例。记录体位转为侧卧位后双肺通气1 min(T_(0))、5 min(T_(1))、10 min(T_(2))以及单肺通气1 min(T3)、5 min(T_(4))、10 min(T_(5))的通气漏气量、Ppeak、PETCO_(2)。记录苏醒期呛咳、声音嘶哑、咽部不适和咳嗽的发生情况。结果两组通气漏气量、Ppeak、PETCO_(2)的均数差值(L组-E组)的95%可信区间(CI)上限均不超过预先设定的非劣效性界值。与E组比较,L组苏醒期呛咳、声音嘶哑、咽部不适和咳嗽等气道并发症发生率明显降低(P<0.05)。结论胸腔镜术中应用喉罩联合支气管封堵器在通气效率方面不劣于气管插管联合支气管封堵器,并且在减少气道并发症方面更具优势。Objective To evaluate the effect of application of a laryngeal mask airway(LMA)combined with a bronchial blocker on pulmonary ventilation in patients undergoing thoracoscopic lung nodule resection.Methods A total of 140 patients who scheduled for elective thoracoscopic lung nodule resection under general anesthesia,55 males and 85 females,aged 18-75 years,BMI<30 kg/m^(2),ASA physical statusⅠ-Ⅲ,were enrolled in the study.The patients were divided into two groups using random number method:endotracheal intubation combined with bronchial blocker group(group E)and laryngeal mask airway combined with bronchial blocker group(group L),70 patients in each group.After positioning the patients to the lateral position,the ventilation leak volume,Ppeak,and P ET CO_(2)were recorded 1 minute(T_(0)),5 minutes(T_(1)),and 10 minutes(T 2)after two lung ventilation,and 1 minute(T_(3)),5 minutes(T_(4)),and 10 minutes(T_(5))after initiating one-lung ventilation.Additionally,the incidence of choking,hoarseness,pharyngeal discomfort,and coughing during the recovery period were recorded.Results The upper 95%confidence interval(CI)of the difference between the mean values of ventilation leakage,Ppeak,and P ET CO_(2)(group L-group E)of the two groups did not exceed the pre-set non-inferiority threshold.Compared with group E,the incidence of airway complications such as coughing,postoperative hoarseness,pharyngeal discomfort and postoperative cough in group L was significantly reduced(P<0.05).Conclusion Laryngeal mask combined with bronchial blocker in thoracoscopic surgery is not inferior to tracheal intubation combined with bronchial blocker in terms of ventilation efficiency,and has more advantageous in reducing airway complications.

关 键 词：喉罩 支气管封堵器 通气漏气量 胸腔镜 单肺通气 

分 类 号：R614[医药卫生—麻醉学]