对比分析支气管封堵器和双腔支气管导管对儿童单肺通气的影响

Comparative Analysis of Effect of Bronchial Blocker and Double-Lumen Tube on One Lung Ventilation in Children

【目的】对比分析支气管封堵器和双腔支气管导管在儿童患者的临床放置及其单肺通气的效果。【方法】56例择期行胸腔镜辅助手术的儿童患者随机分为双腔支气管导管组(group DLT)和支气管封堵器组(group BB),每组28例。两组患者在麻醉诱导后进行支气管封堵器或双腔支气管导管置入。记录两组诱导插管前后血流动力学变化。记录建立双肺隔离时间、一次成功率、肺萎陷程度、重新调整次数、气道峰压、胸膜打开后20 min动脉血气、手术时间、术中缺氧情况以及拔管后早期咽痛声嘶发生率。【结果】与双腔支气管导管组相比,支气管封堵器组建立双肺隔离时间较长,(173.1±75.1)vs(95.6±30.2)s,P<0.05;肺萎陷程度相似,P>0.05;术中平均气道峰压较高,(28.11±5.76)vs(21.57±4.02)cmH2O,P<0.05;胸膜打开后20 min动脉血pH较低,7.35±0.03 vs 7.42±0.06,P<0.05;PaCO2较高,平均(43.01±7.25)vs(35.79±3.17)mmHg,P<0.05;术后早期声音嘶哑发生率较低,14%vs 50%,P<0.05;术后早期咽喉疼痛发生率较低,35%%vs 64%,P<0.05。【结论】对儿童患者,支气管封堵器可实现有效单肺通气和双肺隔离。支气管封堵器咽喉损伤较小,具有一定的优势。

[ Objective ] Our study was to compare the clinical performance and the effect of bronchial blocker and double-lumen tube on one lung ventilation in children undergoing thoracic surgery. [ Methods] Fifty six children undergoing assisted thoracoscopic surgery were randomized into double-lumen tube group （DLT, n = 28） and bronchial blocker group （BB, n = 28）. Anesthetic management and lung isolation were performed according to a standardized protocol. Changes of hemodymics were recorded. The time to initial lung isolation, intubation attempts, collapse score, the number of repositions of the lung isolation device after initial placement, airway pressures, tidal volumes, the arterial blood gases 20 rain after pleural opening and duration of surgery were recorded. [ Results ] Compare with those in DLT, the time to initial lung isolation was longer, （173.1 -＋ 75.1 ） vs （95.6 _＋ 30.2） s, P 〈 0.05; collapse score was similar, peak airway pressure was higher, （28.11 -＋ 5.76） vs （21.57 -＋ 4.02） cmH20, P 〈 0.05; arterial pH was lower （7.35 -＋ 0.03） vs （7.42 ＋ 0.06） ,P 〈 0.05 and arterial PaCO2 was higher 20 rain after pleural opening, （43.01 -＋ 7.25） vs （35.79 _＋ 3.17） mmHg, P 〈 0.05 ; the frequency of early postoperative hoarseness was less, 14% vs 50%, P 〈 0.05 ; the frequency of early postoperative throat pain was less, 35% vs 64%, P 〈 0.05. [Conclusion] The BB provided effective surgical exposure with less throat injuries in children during video-assisted thoracoscopie surgery.