Coopdech管与双腔管在开胸术的应用及对术后声嘶喉痛的对比研究

A comparison study of effects on postoperative hoarseness and sore throat between Coopdech bronchial blocker and double-lumen tube used in thoracotomy

目的比较Coopdech支气管填塞管与双腔管在单肺通气应用的效果及对患者术后声嘶喉痛的影响。方法择期全麻下行食管癌根治术患者100例,ASAⅠ～Ⅲ级,随机分成C组和D组(n=50)。C组采用单腔气管导管(ID7.5～8.0)复合Coopdech支气管填塞管,D组采用双腔支气管导管(35F～37F)。观察气管插管时间、插管尝试次数、术中导管移位次数、支纤镜使用次数,插管前后血流动力学变化,单肺通气时术侧肺塌陷及术野暴露情况,患者术后声嘶喉痛发生率及严重程度。结果两组间相比插管时间C组比D组长,插管尝试次数、术中导管移位次数、支纤镜使用次数D组均比C组多,插管前后MAP、HR变化率D组均比C组高,单肺通气时肺塌陷D组比C组好,患者术后声嘶、喉痛总体发生率D组比C组高(P<0.05)。单肺时术野暴露情况及术后在PACU、1d、2d、3d、>3d时患者声嘶、喉痛组间比较差异无统计学意义(P>0.05)。结论 Coopdech支气管填塞管复合单腔管双肺阻隔效果确切,插管定位方便快捷,刺激小,可减少患者术后声嘶喉痛发生率,具有一定的临床应用前景。

Objective To compare the performance between Coopdech bronchial blocker and double-lumen tube in one-lung ventilation and their effects on postoperative hoarseness and sore throat. Methods One hundred patients scheduled for esophageal cancer radical operation under general anesthesia in the Sun-Yat Sen Cancer Center were selected and randomly divided into group C and group D. One-lung ventilation was achieved by Coopdech bronchial blocker combining with single-lumen endotracheal tube （ID7.5-8.0 group C） and double-lumen tube （35F-37F group D）,respectively. The data related to intubation and positioning was recorded：intubation time,intubation attempts,times of tube displacement,times of bronchofiberscope used etc. The change rate of MAP and HR after intubation,lung collapse and surgical exposure of the operated field during one lung ventilation were observed. The incidence and severity of postoperative hoarseness and sore throat were assessed. Results Intubation time was significantly longer in group C than that in group D （P〈0.05）,while intubation attempts,tube disposition,bronchofiberscope used were significantly more in group D than those in group C （P〈0.05）. The change rate after intubation was significantly greater in group D than that in group C （P〈0.05）. It revealed that lung collapse degree was significantly lower in group D （P=0.029）,though the surgical field exposure showed no significant difference （P=0.596）. The overall incidence of postoperative hoarseness and sore throat was higher in group D than that in group C （P〈0.05）,while the severity showed no statistical difference between the two group in the PACU,24 h,48 h,72 h and more than 72 h after the operation （P〈0.05）. Conclusion Coopdech bronchial blocker combining with single-lumen endotracheal tube used in one-lung ventilation can provide exact lung isolation effects,easy and quick intubation and positioning and can reduce postoperative hoarseness and sore throat. These provide prospect for clinical application.