支气管封堵器单肺通气在新生儿电视胸腔镜手术中的应用

Application of bronchial blocker induced one lung ventilation on neonate undergoing video-assisted thoracoscopicsugery

目的探讨支气管封堵器（bronchial blocker，BB）行单肺通气（one lung ventilation，OLV）在新生儿电视胸腔镜手术（video-assisted thoracoscopicsugery，VATS）中应用的有效性和安全性。方法择期行VATS的患儿60例，按OLV方法完全随机平均分为支气管插管组（A组）和BB组（B组），每组30例。比较两组患儿术前双肺通气时（T0）、OLV 10min（T1）、肺萎陷即刻（T2）、肺萎陷后30min（T3）、肺萎陷后60min（T4）、恢复双肺通气后10min（T5）和术毕6h（T6）、术毕12h（T7）的SpO2、动脉血氧分压（arterial blood partial pressure of oxygen, PaO2）、PET CO2、动脉血二氧化碳分压（arterial blood partial pressure of carbondioxide, PaCO2）、乳酸水平及气道压变化情况，比较两组患儿OLV情况和围术期情况。结果两组息儿气道压从T1开始升高，T4达到最高，T4时A组（34．8±4．9）cmH2O（1cmH2O=0．098kPa）较B组（30．0±4．3）cmH2O更为显著（P〈0．05）；T4时两组患儿SpO2和PaO2下降至最低，两组间比较差异无统计学意义（p〉0．05）；T4时两组患儿PETCO2和PaCO2升至最高，A组较B组更为显著（P〈0．05）；两组患儿乳酸水平呈升高趋势，但各时点差异无统计学意义（P〉0．05）。B组肺萎陷效果、术中出血量、手术时间、拔管时间、监护室时间和气管黏膜损伤情况均显著优于A组（P〈0．05）。结论BB行OLV可为新生儿VATS提供充分的通气和良好的肺萎陷。

Objective To investigate the safety and effectivity of the bronchial blocker （BB） induced one lung ventilation （OLV） on neonateundergoingvideo-assisted thoraeoseopicsugery （VATS）. Methods Sixty neonates undergoing VATS were randomly allocated into 2 groups （n=30）： endobronchial tubes group （A group） and BB group （B group）. SpO2, PET CO2, arterial blood partial pressure of oxygen （PaO2）, arterial blood partial pressure of carbon dioxide （PaCO2）, lactic acid concentration and airway pressure of both groups on two lung ventilation （T0）, 10 min after OLV （T1）, lung deflation achieved （T2）, 30 min （T3） and 60 rain （T4） after lung deflation, 10 rains after two lung ventilation resumed（T5）, 6 h（T6） and 12 h（T7） after operation were recorded. The intubation time, OLV time, time and quality of lung deflation,amount of bleeding, operation time, extubation time, length of stay in ICU, tube malposition and the damage to the airway were recorded. Results A significant decline of SpO2 and PaO2 from T1 to T4 were detected in A and B group respectively （P〈0.05）. A significant increase of PETCO2, PaCO2 and airway pressure （34.8±4.9）, （30.0±4.3） cmH2O （1 cmH2O= 0.098 kPa） from T1 to T4 were detected A and B group respectivly（P〈0.05）, while a more significant increase was observed in A group. No significant difference was found on intubation time between the two groups （P〉0.05）, well OLV time, time and quality of lung deflation,operation time,amount of bleeding, extubation time and length of stay in ICU were detected superior in B group compared with A group, but the incidence of tube malposition was significantly higher in B group（P〈0.05）. Conclusions BB provide effective surgical exposure and sufficient ventilation for neonateundergoing VATS.