人工鼻在胸椎结核手术单肺通气中的应用

Application of heat and moisture exchanger for one-lung ventilation of patients undergoing thoracic vertebrae tuberculosis surgery

目的探讨人工鼻用于胸椎结核手术单肺通气中的安全性和有效性,为其临床应用提供参考依据。方法 60例择期全麻行胸椎后路内固定联合经胸入路病灶清除术患者,随机分为人工鼻组(A组,30例)和非人工鼻组(B组,30例),全麻双腔支气管导管插入后A组在双腔管与麻醉机螺纹管间接人工鼻,B组不接人工鼻,两组均由纤维支气管镜确定或调整导管位置;监测单肺通气前后的气道峰压,计算气道峰压增加率,记录术后患者呼吸道感染和咳嗽、咳痰情况。结果 A组气道峰压增加率(0.353±0.012)%较B组的(0.282±0.020)%略有增加,差异无统计学意义;A组术后呼吸道感染2例、感染率为6.67%,B组呼吸道感染8例、感染率26.67%,两组差异有统计学意义(P<0.05);A组发生咳嗽、咳痰者5例、发生率为16.67%,B组17例、发生率56.67%,两组差异有统计学意义(P<0.01)。结论人工鼻可明显减少术后呼吸道感染、咳嗽、咳痰发生率,不增加气道阻力,可安全有效地应用于胸椎结核手术单肺通气中。

OBJECTIVE To approach the security and efficiency of heat and moisture exchanger （HME） for one-lung ventilation of the patients undergoing thoracic vertebrae tuberculosis surgery through transthoracic approach so as to guide the clinical application. METHODS Totally 60 patients who underwent selective thoracic posterior fixation combined transthoracic approach debridement under general anesthesia were enrolled in the study and randomly divided into the HME group with 30 cases （ group A） and non-HME group with 30 cases （group B）, then one-lung ventilation （OLV） was achieved with double-lumen tube （37 or 39 Fr left-sided DLT）. The correct position of DLT was routinely verified by a fiberoptic bronchoscope （FOB）. A HME was connected between the anesthetic machine and the DLT in group A. The peak pressure of airway was recorded before and after OLV. The incidence rates of respiratory tract infections and cough-expectoration after surgery were compared between the two groups. RESULTS The incremental rate of peak airway pressure of the group A was （0. 353 ±0. 012）%, slightly higher than（0. 282±0. 020） % of the group B, the difference was not significant; there were 2 （6.67%） cases of postoperative respiratory tract infections in the group A and 8 （26. 67%） cases in the group B, the difference in the incidence of postoperative respiratory tract infections between the two groups was significant（P~ 0.05） ; the incidence rate of cough-expectoration was 16.67% （5 cases ） in the group A, 56.67% （17 cases） in the group B, the difference between the two groups was significant（P〈0. 01）. CONCLUSION The HME can significantly reduce the incidence of postoperative respiratory tract infections and cough-expectoration, without increasing the airway pressure, which is safe and effective as being used for one-lung ventilation of the patients undergoing thoracic vertebrae tuberculosis surgery.