Coopdech支气管阻塞管单腔气管导管外置管在胸腔镜手术单肺通气中的应用

The clinical application of coopdech bronchial obstruction tube single lumen endotracheal tube external tube in one-lung ventilation in video-assisted thoracic surgery

目的 观察Coopdech支气管阻塞管单腔气管导管外置管在胸腔镜手术单肺通气中的应用可行性.方法 选择ASA Ⅰ ～Ⅱ级拟行胸腔镜手术患者40例.随机分为双腔支气管导管组（D组,全部选择左侧双腔管）和Coopdech支气管阻塞管导管外置管组（C组）,每组20例.记录两组插管时间、定位时间、导管移位发生率、肺萎陷指标、术后咽痛声嘶发生率.记录两组患者插管前后血流动力学变化,单肺通气前,单肺通气后30min两个时间点的SpO2、PET CO2、PAW变化.结果 C组插管时间、定位时间、导管移位发生率、术中肺萎陷程度与D组比较差异无统计学意义（P＞0.05）,C组术后患者声音嘶哑及咽喉痛发生率明显低于D组（P＜0.05）.插管前即刻D、C两组MAP、HR比较差异无统计学意义（P＞0.05）.插管后即刻两组的MAP及HR均较插管前即刻增高（P＜0.05）,但D组较C组升高明显（P＜0.05）.单肺通气前D、C两组的气道压峰值比较差异无统计学意义.单肺通气后两组的气道压峰值较双肺通气均升高（P＜0.05）,但C组气道压峰值升高明显低于D组（P＜0.05）.单肺通气前后SpO2、PET CO2比较差异无统计学意义（P＞0.05）.结论 Coopdech支气管阻塞管单腔气管导管外置管插管简便、定位准确、肺萎陷和手术野暴露良好,且与DLT相比气管插管反应轻、气道阻力较小、术后声嘶咽痛发生率低,可安全用于胸腔镜手术.

Objective To investigate the feasibility of applying coopdech bronchial obstruction tube single lumen endotracheal tube external tube in one - lung ventilation in video - assisted thoracic surgery （VAST）. Methods Forty patients who need to undergoing VATS were randomly divided into group D and C. One - lung ventilation was achieved by double - lumen tube in group D （ n = 20） and coopdech bronchial blocker tube combined with single - lumen endotracheal tube in group C （n = 20）. Record the time of inserting and positioning, incidence of catheter displacement and postoperative sore throat hoarseness, index of pulmonary collapse. The change of hemodynamic, SpO2, PETCO2 and PAW before and after intubation of the two groups were record and compared. Results The differences of the time of positioning, incidence of catheter displacement and degree of pulmonary collapse between the two groups were not statistically significant （P 〉 0. 05 ）. Meanwhile, the incidence of postoperative sore throat and hoarseness in group C were obviously lower than control group （ P 〈 0. 05 ）. MAP and HR of the two groups were significantly increased after inserting, and MAP and HR increased more in group D （ P 〈 0. 05 ）. Airway pressure peak of the two groups were raised after intubation, and the ascent of airway pressure peak in group C was lower than that in group D （ P 〈 0. 05 ）. The differences of pre -/post - intubation SpO2 and PETCO2 between the two groups were not statistically significant （P 〉 0. 05 ）. Conclusions It is more safe and reliable to apply coopdech bronchial obstruction tube single lumen endotracheal tube external tube in VAST because of convenient intubation, accurate positioning, favorable pulmonary collapse and surgical field exposure, lower airway resistance and incidence of postoperative hoarseness sore throat compared with DLT endotracheal intubation.