不同双腔气管插管单侧肺通气的临床效果和解剖学比较

Clincal effect and anatomy of single lung ventilation by double-lumen endotracheal intubation

目的探讨在微创胸腔镜术中不同双腔气管插管方法观察手术野肺萎陷和肺通气的效果。方法以患者入院日期单双号不同将120例肺大泡自发性气胸患者分为单左管组60例和左右管组60例,采用不同的气管插管方法,术中观察手术侧肺萎陷程度,术后计算手术时间、出血量、胸腔引流量、肺漏气时间和白细胞计数等指标并进行比较。结果左右管组麻醉中肺的萎陷度达到50%者占48%,肺萎陷度达70%者占32%,而单左管组肺萎陷度达50%和70%者分别占5.00%和93%(P<0.01),差异有统计学著意义;单左管组的手术时间和术后反应指标均比左右管组显著降低,P<0.01,差异有统计学著意义。结论左侧双腔气管插管在术中控制肺膨胀和维持肺通气方面比右侧气管插管有明显的优势,建议无论左胸或右胸施行胸腔镜手术尽量选择左侧双腔气管插管麻醉。

Objective To investigate the effects of two different methods of double-lumen endotracheal intubation in minimally invasive thoracoscopic surgery. Methods Based on different methods of endotracheal intubation,120 patients with bullae and spontaneous pneumo-thorax were randomly divided into the single left intubation group （60 cases） and the left and right intubation group （60 cases）. The opera-tion time,blood loss,chest drainage volume,the time of pulmonary air leaks,white blood cell count and other indexes of the two groups were evaluated. Results The proportion of patients whose atelectasis degree was over 50% in the left and right intubation group occupied 48%, and it occupied 32% in patients whose atelectasis degree was over 70%. While the corresponding data in the single left intubation group were 5. 00% and 93% respectively. The differences were statistically significant （P〈0. 01）. The operative time and postoperative indicators of the single left intubation group were more significantly lower than those in the left and right intubation group. Conclusion The left double-lu-men endotracheal intubation has obvious advantages in maintenance and control of lung expansion and pulmonary ventilation during surgery, and it should be used in video assisted thoracoscopy surgery.