不同支气管导管及支气管阻塞导管在开胸单肺通气患者中的应用

A comparison of double-lumen endotracheal tube with univent blocker and bronchial blocker during thoracic surgical anesthesia

目的比较双腔支气管导管、单腔双囊支气管导管及支气管阻塞导管3种肺隔离技术在胸外科手术中应用的利与弊。方法美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、肺通气功能正常、择期行左开胸手术的患者120例，应用数字随机法分为双腔支气管导管（D1月）组、单腔双囊支气管导管（UNI）组和支气管阻塞导管（BB）3组，每组40例。麻醉诱导后分别插入不同支气管导管，应用纤维支气管镜判断插管位置，开胸后行单肺通气。观察插管定位所用时间；气管插管后5min记录各组血流动力学参数；开胸后观察肺萎陷情况及血气变化；连续观察患者气道峰压（Ppeak）、气道平台压（Pplat）、气道阻力（Raw）、气道顺应性（Comp）等；术后24h随访术后咽喉痛发生率。结果插管定位所用时间3组比较，差异无统计学意义；DLT组插管后5min时平均动脉压（MAP）及心率显著高于UNI组和BB组（P〈0．05）；3组患者开胸后5、10min时肺萎陷评分，差异无统计学意义（P〉0．05）。DLT组单肺通气时Ppeak、Pplat均高于UNI组和BB组（P〈0．05），Comp低于UNI组和BB组（P〈0．05）；3组术中导管移位次数分别为DLT组4次、UNI组5次、BB组8次，BB组明显高于DLT组及UNI组（P〈0．05）；DLT组（70％）术后咽喉痛发生率显著高于UNI组（37．5％）和BB组（22．5％）（P〈0．01）。结论Univent导管和支气管阻塞导管可减少插管造成的气道损伤，改善胸科手术单肺通气时的顺应性，但术中导管移位的发生率较高。

Objective To compare the effectiveness of lung isolation among double-lumen endotracheal tube, Univent blocker and bronchial blocker during thoracic surgical anesthesia. Methods A total of 120 patients undergoing elective thoracic surgery were enrolled. They were intubated with Mallinekrodt DLT （DLT group, n = 40）, Univent blocker （UNI group, n = 40 ） and Coopdech bronchial blocker （ BB group, n = 40） after intravenous anesthesia induction. The following parameters were recorded ： （1） time to initially position the assigned tube; （2） changes of mean arterial pressure （MAP） and heart rate （HR） at 5 min post-intubation ; （3） lung collapse scores ; （4） frequency of malpositions ; （5） airway press and blood gas change during one lung ventilation （ OLV ） ; （ 6 ） postoperative sore throat at 24 h postoperation. Results No statistical difference existed in positioning three types of endotracheal tubes. But MAP and HR were higher at post-intubation in DLT group compared with the other 2 groups. No difference existed among the lung isolation devices in lung collapse scores at 5/10 min after pleural opening. As compared with the UNI and BB groups, Ppeak and Pplat increased while compliance decreased in DLT group during OLV. Statistical differences existed in tube malpositions among three groups （ n = 4, DLT; n = 5, UNI; n =8, BB）. The incidence of postoperative sore throat was significantly higher in DLT group （70%） than the other two groups （37.5%, UNI; 22. 5%, BB）. Conclusion As compared with DLT, Univent and Coopdech bronchial blocker may reduce the airway injury and improve the compliance during OLV. But there is a higher intraoperative incidence of tube malposition.