双腔支气管导管与Univent管在纤维支气管镜引导下应用于单肺通气的临床研究

CLINICAL STUDY ON SAFETY AND EFFICACY OF DOUBLE-LUMEN ENDOBRONCHIAL TUBE AND UNIVENT TUBE GUIDED BY FIBEROBRONCHOSCOPE USED IN ONE-LUNG VENTILATION

目的在纤维支气管镜引导下行气管插管术，比较双腔支气管导管与Univent管应用于单肺通气的安全性和有效性。方法选取100例ASA Ⅰ／Ⅱ级年龄在18-65岁需行单肺通气的全麻患者，采用计算机随机法分为双腔支气管组（A组）和Univent管组（B组），每组50例。静脉麻醉诱导，待患者意识丧失、肌肉松弛后在纤维支气管镜引导下行气管插管操作。观察并记录气管插管时间、一次性成功率、声门暴露时间；气管插管相关并发症；麻醉诱导前后及单肺通气（OLV）后血流动力学、心率变化；双肺通气及单肺通气时血氧饱和度、气道压力、呼气末二氧化碳分压变化；术中OLV时肺萎陷及手术视野暴露情况。结果①Univent管组插管时间较双腔支气管组明显缩短；②气管插管并发症发生率Univent管组明显低于双腔支气管组（P〈0．05）；③麻醉诱导前后二组血流动力学变化情况相似（P〉0．05）；④双肺通气及单肺通气时血氧饱和度、呼气末二氧化碳分压情况相似（P〉0．05），而气道压力Univent管组较双腔支气管导管组明显更低（P〈0．05）；⑤二组术中单肺通气时肺萎陷率及手术视野暴露率差异无统计学意义（P〉0．05）。结论双腔支气管导管及Univent管应用于OLV时均安全有效，同样在纤维支气管镜引导下行气管插管术，Univent管较双腔支气管导管所需时间明显缩短，而气管插管并发症则显著降低。

Objective To study the effectiveness and security of double lumen endobronchial tube （DLT） and univent tube guided by fibrobronchoscopy （FOB） used in one- lung ventilation （OLV）. Methods One hundred ASA Ⅰ / Ⅱ patients aged from 18 to 65 years who needed general anesthesia and OLV were selected. They were assigned into DLT group （group A） and univent tube group （group B） by computer randomly, each of 50 patients. After a routine intravenous anesthetic induction, and when the patient＇s consciousness was lost and muscles were relaxed, tracheal intubation guided by FOB was performed. The time of tracheal intubation, one- time intubation achievement ratio, time of glottis exposure, complications of endotracheal intubation, the changes of hemodynamics and heart rate before and after anesthetic induction and OLV, the changes of saturation of blood oxygen, airway pressure and partial pressure of carbon dioxide in endexpiratory gas during OLV and double- lung ventilation （DLV）, pulmonary collapse and the exposure of operative field at the time of OLV were recorded. Results The time of tracheal intubation in the group B was significantly shorter than that in the group A （P〈0.05）. The incidence of endotracheal intubation complications in the group B was significantly lower than it in the group A （P〈0.05）. The changes of hemodynamics in the two groups were analogous before and after anesthetic induction（P〈0.05）. The changes of saturation of blood oxygen and partial pressure of carbon dioxide in endexpiratory gas were similar in time of OLV and DLV（P〈0.05）, but the airway pressure in the group B was significantly lower than taht in the group A （P〈0.05）. There were no significantly discrepancy in the pulmonary collapse and the exposure of operative field at the time of OLV（P〈0.05） between the two groups,. Conclusions Both of DLT and univent tube used in OLV are safe and effective, while for endotracheal intubation guided by FOB, compared to DLT, in the univent tube group the time is shorter and the incidence of endotracheal intubation complications is lower.