Supreme喉罩联合Coopdech支气管阻塞器用于食道癌根治术患者气道管理效果

Effiacy of Coopdech bronchial blocker combined with a laryngeal mask airway Supreme for airway management in patients undergoing esophageal carcinoma resection

目的评价Supreme喉罩联合Coopdech支气管阻塞器用于食道癌根治术患者气道管理的可行性和效果。方法采用随机数字表法将择期全麻下行经胸食道癌根治术患者60例，美国麻醉医师协会（ASA）分级I～Ⅲ级，年龄65岁～78岁，随机分为3组（每组20例）：双腔支气管插管组（DT组），Coopdech支气管阻塞器组（TC组）和Supreme喉罩联合Coopdech支气管阻塞器（sc组）。记录一次插管成功率及插管和定位时间；观察术中导管移位、需行纤维支气管镜检查例数和评价术中肺萎陷的情况；术后24h咽喉疼痛及声音嘶哑和术后肺不张的发生例数；观察麻醉前（T0），插管即刻（T1），插管后1（T2）、3（T3）、5min（T4）的血流动力学和脑电双频指数（bispectral index，BIS）变化；记录双肺通气10min（T5），单肺通气（one lung ventilation，OLV）10（T6）、30（T7）、60min（TR）时气道压（airway pressure，Paw）和呼气末二氧化碳分压（end tidal carbon dioxide partial pressure，PETCO2）。结果与DT组比较，TC组和SC组的插管和定位时间明显短于DT组（P〈0．05），TC组和sc组间差异无统计学意义（P〉0．05）；与T1时刻比较，在T2-4时刻，DT组和Tc组收缩压（systolic pressure，SP）、舒张压（diastolic pressure，DP）、心率（heart rate，HR）及BIS明显升高（P〈0．05），SC组BP、DP、HR和BIS无明显变化（P〉0．05）；与DT组比较，SC组和TC组T2-4时刻BP、DP、HR和BIS明显降低（P〈0．05）；术中OLV（T6-8）时，DT组气道压力明显高于sc组（P〈0．05），3组间PETCO2差异无统计学意义（P〉0．05）；术中导管移位、需行纤维支气管镜检查例数、肺萎陷程度差异、术后肺不张发生率3组差异无统计学意义（P〉0．05）；sc组术后24h咽喉疼痛、声音嘶哑（20％）发生率，明显低于DT组（85％）和TC组（45％）（P〈0．05或P〈0．01）。结论Supreme喉罩联合Coopdech支气管阻塞器可安全用于食道癌根治术患者气道管理。

Objective To evaluate the efficacy of Coopdech bronchial blocker combined with a laryngeal mask airway Supreme for airway management in patients undergoing esophageal carinoma resection. Methods Sixty patients undegoing esophageal carcinoma resection were randomly divided into 3 groups （n=20）： double-lumen tube group （group DT）, Coopdecb bronchial blocker combined with single-lumen tube group （group TC） and Coopdeeh bronchial blocker combined with a laryngeal mask airway Supreme group （group SC ）. The fiberoptic bronchoscope was used to assist endotracheal tube positioning in both groups. The first attempt success rates of intubation, the intubation time, positioning time, the number of fiberoptic bronchoscopy attempts, degree of lung collapse, postoperative atelectasis, postoperative sore throat and hoarseness were recorded. Blood pressure （BP）, heart rate （HR） and bispectral index （BIS） were recorded before anesthesia（T0）,immediately after intubation（T~） and at 1, 3 rain and 5 min after intubation （T24）. Airway pressure （Paw） and end tidal carbon dioxide partial pressure （PzrCO2） was recorded at two lung ventilation 10 min（Ts） and 10 （T6）, 30（T7）, 60 min（Ts） after one lung ventilation（OLV）. Results Compared to group DT, The intubation time and the positioning time was significantly shorter in group TC and group SC. Compared with T~, HR, BP and BIS significantly increased in group TC and group SC group at number of patients required for tube Tz4. Compared with group group DT, there was no significant difference in SP, DP, HR, BIS, the displacement, the number of fiberoptic bronchoscopy attempts and degree of lung collapse among the three groups. Paw was significantly higher during OLV at group DT than group SC. Incidences of postoperative sore throat and hoarseness were significantly lower in group SC （20%） compared to group DT （80%） and group TC （45%）. Conclusions The efficacy of the Coopdech bronchial blocker combined laryngeal mask airway Supreme is safe in patents undergoing esophageal carinoma resection.