支气管封堵器与双腔支气管导管实现单肺通气的安全性比较

Comparison of safety between double lumen-tube and endobronchial occluder for single-lung ventilation

背景:插双腔支气管导管实现单肺通气是临床上最常应用的方法,但导管放置和定位耗时较长,支气管、声带、咽喉等受损害的并发症较多。目的:比较应用双腔支气管导管及支气管封堵器行单肺通气的安全性,及对术后声带损伤﹑声音嘶哑﹑咽喉痛的影响。设计、时间及地点:随机对照观察,于2006-01/2007-10在浙江省宁波市医疗中心李惠利医院完成。对象:选择需单肺通气择期行食管癌根治术的患者100例。随机分为封堵器组和双腔支气管组各50例。方法:封堵器组通过支气管封堵器实现单肺通气,双腔支气管组通过插入双腔支气管导管实现单肺通气。所有气管插管均由同一个熟练的麻醉医生完成。主要观察指标:①完成插管所用时间。②单肺通气时肺萎陷质量和外科术野暴露程度。③治疗后24,48,72h采用标准化问题对声音嘶哑和咽喉痛进行评估,术后立即利用纤维支气管镜进行支气管和声带损伤的检查。结果:①双腔支气管组的插管时间明显较封堵器组长(P<0.05)。②单肺通气时肺萎陷质量和外科术野暴露程度在两组间差异均无显著性意义(P>0.05)。③双腔支气管组术后声带损伤、声音嘶哑及咽喉疼痛的发生率较封堵器组显著升高(P<0.05)。⑤两组支气管损伤的发生率基本一致(P>0.05),两组患者均未发生如支气管断裂等严重并发症。结论:双腔支气管导管和封堵支气管导管在食管癌根治术患者行单肺通气中的应用均安全有效,应用封堵器可减少患者术后声带损伤、声音嘶哑及咽喉疼痛的发生率,在适应证范围内可以首先选用封堵支气管导管。

BACKGROUND： Double lumen-tube is frequently used in clinic for single-lung ventilation. However, the tube placement and location takes much time and there are many complications such injured bronchus, vocal cord and throat postoperatively. OBJECTIVE： To compare the safety and impact on the incidence and severity of postoperative hoarseness, vocal cord lesions and sore throat between double lumen-tube and endobronchial occluder for single-lung ventilation. DESIGN, TIME AND SETTING： Randomized controlled observation was performed at Ningbo Medical Treatment Center Lihuili Hospital from January 2006 to October 2007. PARTICIPANTS： 100 patients who underwent resection of esophageal cancer by single-lung ventilation were randomly divided into endobronchial occluder and double lumen-tube groups （n =50）. METHODS： All patients were subjected to single-lung ventilation by endobronchial occluder or double lumen-tube, respectively The tracheal intubation was performed by the same anesthetist. MAIN OUTCOME MEASURES：①The time for intubation; ②Atelectasis and exposure extent in surgery at single-lung ventilation; ③Postoperative hoarseness and sore throat were assessed at 24, 48 and 72 hours, and bronchial injuries and vocal cord lesions were examined by bronchoscopy immediately after surgery. RESULTS： The time for intubation in double lumen-tube group was longer than endobroncbial occluder group （P 〈 0.05）. There were no significant differences in mean arterial blood pressure and basic vital sign before and after intubation between two groups （P 〉 0.05）. There were no significant differences in atelectasis and exposure extent in surgery between two groups （P 〉 0.05）. Postoperative hoarseness occurred significantly more frequently in the double-lumen group than in the endobronchial occluder group （P 〈 0.05）. The incidence of bronchial injuries was nearly equivalent in two groups （P 〉 0.05）. No major complications such as bronchial ruptures were observed in both groups. CONCLUSION： Single-lung ventilation can be achieved via either a double lumen-tube or an endobronchial occluder. However, occluder is recommended for single-lung ventilation because it can reduce the incidence of vocal cord injuries, postoperative hoarseness, and sore throat.