Arndt管和双腔管用于单肺通气的比较研究

The Comparison between the Double-lumen Tube and Arndt Wire-guided Endobronchial Blocker on One-lung Ventilation

目的通过比较DLT和Arndt管,熟悉各自的特点,合理的选择应用它们.方法38名择期胸外科手术患者,术中需单肺通气,随机分为两组:DLT组(double lumen tube,n=20)和Arndt(arndt wireguided cndobronchial blocker,n=18)组.DLT组患者用双腔管插管,Arndt组用Arndt管插管.记录插管失败次数、翻身后气管导管移位次数、需纤支镜检查的次数、置管时间、肺萎陷时间、肺隔离的质量、气道峰压等.结果翻身后气管导管移位次数、需纤支镜检查的次数、插管失败次数、肺隔离的质量无统计学意义.而置管时间、肺萎陷时间、气道峰压有统计学意义.结论Arndt管是达到单肺通气的一种方法,它的主要优点是可以通过普通的气管导管达到单肺通气,术后带管病人不需要换管,在纤支镜的引导下Arndt管能快速准确的定位置管.

Objective To select and apply DLT and Amdt wire -guided endobronchial blocker appropriately by comparing them and learning their characteristics. Methods Thirty - eight patients undergoing prolonged OLV during elective thoracic surgery were randomly divided into two groups： （ 1 ） double - lumen tube （ group D, n = 20） ; （2） Arndt wire - guided endobronchial blocker （ group A, n = 18 ）. The patients in group D （ n = 20） were intubated with double - lumen tube while those in Group A （ n = 18 ） were intubated with wire -guided endobronchial blocker （WEB）. The number of unsuccessful placement attempts, the number of dislodgements of the device after turning the patient into the lateral position and the number of applying FOB were counted. The duration of the operation during one - lung ventilation, peak inspiratory pressure, intubation, and pulmonary collapse were recorded. The quality of lung sequestration was also rated by the surgeon under direct visualization as either excellent, fair, or poor. Results There were no statistically significant differences in the 2 groups in the frequency of unsuccessful placement, tube displacement after turning the patient into the lateral position, and the application of FOB mean operative time number of required bronchoscopes, and the quality of lung sequestration as assessed by the surgeon （blinded to technique ） once lung sequestration was achieved. There was statistically significance in the duration of intubation, pulmonary collapse and peak inspiratory pressure. The Arndt blocker took slightly longer to place （ 3.61±0.38） min compared to the DLT （ 3.12 ±0.51 ） min of time . The Arndt blocker took slightly longer to deflate lung （26. 28 ± 3.16） compared to the DLT （ 18.60 ±2. 78） groups. Peak inspiratory pressure of A group （24.4±5. 12） were higher than the DLT （30.9 ±5.49） . Conclusion Wire -guided endobronchial blocker is the alternative method to one -lung ventilation. The main advantage of this system is that it makes one - lung ventilation possible with a conventional endotracheal tube. There is no need to re - intubate the patient after the operation. The WEB mechanism allows timely and quick incubation under the guide of fiber - optic bronchoscope.