支气管封堵器在胸科手术中的应用分析

The Analysis of Application of Bronchial Occluder in Thoracic Surgery

目的对胸科手术使用支气管封堵器进行单肺通气,观察其与双腔气管气管插管插管的差别。方法方便收集2010年1月—2016年12月期间该院收治的80例ASAⅠ~Ⅱ级年龄18~60岁术前访视患者对气道进行综合评估分为Ⅰ~Ⅲ级(Mallampati分级)需单肺通气胸科手术的患者全按方法不同随机分为双腔气管导管组和支气管封堵器组,每组40例。两组均在纤维支气管镜下定位完成插管。观察其与双腔气管气管插管插管前后平均动脉压(MAP),心率(HR)变化以及术中气道压(cm H_2O)变化,两组插管时间(min)及成功率(%)。结果两组插管后MAP、HR均较插管前改变,差异有统计学意义(P<0.05),且插管后双腔气管导管的MAP(99.3±11.6)mmHg,HR(90.4±12.1)次均较封堵器组(81.4±11.1)mmHg,(76.5±10.2)次高,差异有统计学意义(P<0.05)。两组气管插管单肺通气前后气道峰压封堵器组(24±4.0)cm H_2O双腔气管导管组(25±3.0)cm H_2O,差异无统计学意义(P>0.05),两组插管时间差异无统计学意义。两组在气道分级Ⅰ~Ⅲ级插管成功率情况比较差异无统计学意义(P>0.05)。但Ⅳ级气道封堵器组(3/4)插管成功率明显高于双腔气管导管组(0/3),差异有统计学意义(P<0.05)。插管后24 h咽喉痛、声音嘶哑的发生率双腔气管导管组90.0%(36/40),封堵器组35.0%(14/40)双腔气管导管组明显增高。两组中双腔气管导管组2例,封堵器组3例在术中移位。结论支气管封堵器其操作简单,插管及拔管时对循环功能的干扰小,咽喉痛、声音嘶哑的发生率低,调整套囊位置容易,对分泌物少,手术时间短的开胸手术是一种简单、实用、行单肺通气的方法。

Objective To thoracic surgery using bronchial occluder for single lung ventilation,observe its differences with double lumen endotracheal intubation tracheal intubation.Methods Collected from January 2010 to December 2016,80 cases of ASA Ⅰ~Ⅱ level during the age of 18 to 60 patients with preoperative visits for integrated evaluation of the airway are rated Ⅰ~ Ⅲ one-lung general pneumothorax(Mallampati hierarchical) need the surgery of patients with full according to the different methods were randomly divided into double lumen endotracheal tube and bronchial occluder group,40 cases in each group.In the two groups are completed under the fibre bronchoscope positioning intubation.With double lumen endotracheal intubation tracheal intubation was observed before and after the mean arterial pressure(MAP),heart rate(HR) and intraoperative airway pressure(cm H_2O) changes,success rate of intubation time(min) and the two groups(%).Results Two groups after intubation MAP and HR is intubation before the change,the difference was statistically significant(P<0.05),and after intubation double lumen endotracheal tube MAP(99.3±11.6)mmHg,HR(90.4±12.1)times were(81.4±11.1)mmHg in the closure group(76.5±10.2)times,the difference was statistically significant(P<0.05).Two groups of one-lung ventilation airway peak pressure closure before and after endotracheal intubation group of(24±4.0) cm H_2O double lumen endotracheal tube group(25±3.0) cm H_2O,there was no statistically significant difference(P>0.05),no difference between the two groups of intubation time(min).In the two groups in airway class Ⅰ~ Ⅲ success rate of intubation compared differences no statistical significance(P>0.05).But Ⅳ level(3/4) success rate of intubation airway closure group was obviously higher than that of double lumen endotracheal tube group(0/3),the difference was statistically significant(P<0.05).24 h after intubation of a sore throat,the incidence of hoarse double lumen endotracheal tube group 90.0%(36/40),closure group 35.0%(14/40) double lumen endotracheal tube group increased obviously.Two groups were double lumen endotracheal tube in 2 cases,displacement of closure group in 3 cases.Conclusion Bronchial occluder its operation is simple,intubation and extubation of circulatory function disturbance is small,sore throat,low incidence of hoarse,adjust the set of sac location easily,less for secretion,shorter operation time of open thoracic surgery is a simple,practical and one-lung ventilation method.