两种支气管导管应用于胸腔镜下食管癌根治术的临床观察

Clinical observation of the two bronchial catheter be used in thoracoscopic radical resection of esophageal cancer

目的观察两种支气管导管应用于胸腔镜下食管癌根治术单肺通气的临床效果。方法选择我院2011年7月～2012年4月行胸腔镜下食管癌根治术的患者40例,依住院号的奇偶数分为支气管封堵导管组(A组,尾数为奇数)和双腔支气管导管组(B组,尾数为偶数),每组各20例。比较两组患者肺萎陷程度和单肺通气前、单肺通气后0.5、1、2 h时的收缩压、舒张压、心率、动脉血氧分压(PaO2)、二氧化碳分压(PCO2)、血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)及气道压力(Paw)的变化和术后声嘶咽痛发生率。结果两组肺萎陷和血流动力学指标比较差异无统计学意义(P>0.05);A组患者在单肺通气0.5、1、2 h时Paw、PCO2、PETCO2低于B组,PaO2、SpO2高于B组,差异有统计学意义(P<0.05);声嘶咽痛发生率少于B组(P<0.05)。结论支气管封堵管与双腔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,但支气管封堵管具有插管和定位容易、氧合充分、气道压力低、术后声嘶咽痛发生率少、术野暴露满意的优势,在其适应证内可以首选支气管封堵管。

Objective To observe the clinical effects of two bronchial catheters in the single-lung ventilation by the thoracoscopic radical resection of esophageal cancer.Methods 40 patients undergoing the thoracoscopic radical resection of esophageal cancer were divided into 2 groups： bronchial blocking catheter（group A,the mantissa of their admission number was odd number） and double-lumen bronchial catheter（group B,the mantissa of their admission number was even number） from July 2011 to April 2012 of my hospital,with 20 cases in each group.The atelectasis at single-lung ventilation and 2 groups changes of patients with systolic blood pressure,diastolic blood pressure,heart rate,arterial partial pressure of oxygen（PaO2）,carbon dioxide partial pressure（PCO2）,oxygen saturation（SpO2）,end-tidal carbon dioxide partial pressure（PETCO2）,airway pressure（Paw） before single-lung ventilation,on 0.5 h,1 h,2 h after single-lung ventilation and incidence of postoperative hoarseness and sore throat were compared.Results There were no significant differences in hemodynamic and the atelectasis between the two groups（P〈0.05）.On 0.5,1,2 h single-lung ventilation,Paw,PCO2,PETCO2 of group A were lower than group B,and PaO2,SpO2 of group A were higher than those in group B（P〈0.05）.The incidence of hoarseness and sore throat of group A were significantly less than that in group B（P〈0.05）.Conclusion Single-lung ventilation has achieved via either the double lumen tube or the bronchial blocking catheter.However,the bronchial blocking catheter recommend for single-lung ventilation because of the advantages of its easy intubation and position,full oxygenation,low Paw,less incidence of postoperative hoarseness and sore throat,good exposure.