支气管封堵器与双腔支气管导管用于胸科手术患者单肺通气效果的比较

Effect comparison of bronchial occlusive device and double-lumen bronchial tube on one-lung ventilation of thoracic surgery patients

目的探讨支气管封堵器和双腔支气管导管在胸科手术患者单肺通气的效果。方法选取2014年12月～2015年2月于我院行胸科手术患者60例，随机分为支气管封堵组（BB组）和双腔支气管导管组（DLT组），每组30例。麻醉诱导后，BB组通过支气管封堵器实现双肺通气，DLT组通过双腔支气管导管实现双肺通气。记录两组插管前、后和拔管前、后的平均动脉压（MAP）、心率（HR）、插管定位的时间、单肺通气前及单肺通气后的气道压力、肺萎陷质量、胸膜打开后20min的动脉血气记录PaO2及PaCO2、气管拔管早期咽痛及声音嘶哑的发生情况。结果两组插管前MAP、HR比较差异无统计学意义（P〉0．05），DLT组插管后及拔管后的MAP及HR较BB组明显升高（P〈0．05）。BB组建立单肺通气的时间短，单肺通气开始后气道压低，术后咽痛和声音嘶哑发生率降低（P〈0．05），胸膜打开后20min动脉血气的PaO2及PaCO2比较差异无统计学意义（P〉0．05），两组术侧肺萎陷质量比较差异无统计学意义（P〉0．05）。结论与双腔支气管导管比较，支气管封堵器单肺通气效果满意，血流动力学稳定。对咽喉的损伤较小，是一种切实可行的单肺通气方法。

Objective To explore the effects of bronchial occlusive device and double-lumen bronchial tube on the one-lung ventilation of thoracic surgery patients. Methods Sixty patients who underwent thoracic surgery in our hospi- tal from December 2014 to February 2015 were randomly divided into the bronchial occlusive device group （BB group） and double-lumen bronchial tube（DLT group）, with 30 patients in each group. After anesthesia induction, the BB group achieved two-lung ventilation through bronchial occlusive device and the DLT group achieved two-lung ventilation through double-lumen bronchial tube. The mean arterial pressure （MAP） and heart rates （HR） before and after intuba- tion and before and after extubation, intubation positioning time, airway pressure before and after one-lung ventilation, lung collapse quality, arterial blood gas PaO2 and PaCO2 20 minutes after pleural opening, and occurrence of sore throat and hoarseness in the early stage of tracheal extubation of the two groups were recorded. Results The differences in MAP and HR between the two groups were not statistically significant before intubation （P〉0.05）, and MAP and HR after intubation and after extubation of the DLT group increased significantly compared to those of the BB group （P〈0.05）. The BB group had shorter one-lung ventilation establishment time, lower airway pressure after the start of one-lung ventilation, and lower incidences of postoperative sore throat and hoarseness （P〈0.05）; the differences in arterial blood gas PaO2 and PaCO2 20 minutes after pleural opening were not statistically significant （P〉0.05）, and the difference in operation side lung collapse quality between the two groups was not statistically significant（P〉0.05）. Conclusion Com- pared to double-lumen bronchial tube, bronchial occlusive device shows more satisfactory one-lung ventilation effect, higher hemodynamic stability and smaller throat injury, which is a feasible and practical one-lung ventilation method.