学龄前儿童胸腔镜手术两种单肺通气方法的临床观察

Clinical observation of two methods used for one-lung ventilation in thoracoscope operation in preschool children

目的比较单腔支气管插管和Univent导管用于学龄前儿童(3～6岁)择期胸腔镜手术中单肺通气的临床效果。结论选择学龄前儿童择期胸腔镜手术患者34例,术中均需行单肺通气,随机分为支气管插管组(B组)和Univent组(U组)。观察并记录盲插成功率、插管定位时间、肺塌陷质量、术中导管移位次数、单肺通气期间气道峰压增加率、气道损伤评分、术后咽痛和声嘶发生率、术后24h胸片对比术前肺炎情况。结果两组的盲插成功率、插管定位时间、气道损伤评分和术后咽痛声嘶发生率差异无统计学意义。肺塌陷质量B组明显低于U组(P<0.05);单肺通气期间的气道峰压增加率、导管移动次数和术后肺炎加重率B组明显高于U组(P<0.05)。结论 Univent导管用于单肺通气与单腔支气管插管相比可明显改善肺塌陷质量,降低单肺通气期间的气道峰压值,改善术中导管移位,降低术后肺炎发生率,比单腔支气管插管具有明显优势。

Objective To compare the clinical effect of bronchial cannula and univent tube used for one-lung ventilation in preschool children receiving elective thoracoscope surgery..Methods 34 children needed one-lung ventilation during thoracoscope surgery were randomly assigned to receive one-lung ventilation with univent tube（group U,n=17）or with bronchial cannula（group B,n=17）. Parameters such as：ration of successful blind intubation,time required for intubation and correct positioning,rate of increased peak airway pressure during one-lung ventilation,quality of lung collapse,degree of tracheal and bronchial injuries,and incidence of sore throat and hoarseness after surgery,and pneumonia after twenty-four after operation were recorded. Results No statistical differences were found in the time required for intubation and positioning, ration of successful blind intubation,frequencies of malposition during operation,and degree of tracheal/bronchia injuries, and incidence of sore throat and hoarseness after surgery between the two groups.A Ppeak,frequencies of malposition during operation were lower in group U than those in group B（P0.05）.The quality of lung collapse was higher in group U than those in group B（P0.05）. Conclusion Univent tube is effective for one-lung ventilation,it can improve efficacy of one-lung ventilation, and can reduce pneumonia after surgery and the patient satisfaction of anesthesia.