胸外科手术麻醉中双腔支气管导管插管方法的研究

Study on the Method of Double-lumen Bronchial Catheterization in Thoracic surgery

目的:研究胸外手术麻醉中双腔支气管导管插管方法。方法:在2012年7月~2016年7月收治的行胸外科手术患者中随机抽取82例作为研究对象,全部患者均行气管插管全麻,根据插管方法的不同将患者分为观察组与对照组,对照组患者给予常规的听诊法插管,最后采用纤维支气管镜精确定位;观察组患者则在纤维支气管镜引导下进行双腔支气管导管插管,分析两组患者准确定位成功率、定位耗费时间、不同时间点的心率和平均动脉压等指标值。结果:观察组准确定位成功率(95.24%)比对照组高(62.5%),而定位耗时更短(P均<0.05);术中观察组患者的心率、平均动脉压波动小,插管前后比较无统计学意义(P>0.05)。而对照组患者心率、平均动脉压波动较大,插管前后比较有统计学意义(P<0.05);插管结束即刻、插管结束3 min,观察组心率和平均动脉压均低于对照组,2组比较均有统计学意义(P均<0.05);观察组术中低氧血症发生率与对照组比较,P>0.05;观察组术后气管插管并发症发生率与对照组比较,P>0.05。结论:纤维支气管镜引导下双腔支气管导管插管用于胸外科手术麻醉中效果显著,能快速准确定位,对患者的影响小,有助于保证手术的顺利开展,效果确切,值得推广应用。

Objective：To study the method of intubation with double-lumen bronchial catheter during thoracic anesthesia. Methods A total of 82 patients were randomly selected from our hospital between July 2012 and July 2016. All patients underwent tracheal intubation and general anesthesia. According to the different methods of intubation, the patients were divided into the observation group and the control group. The patients in the control group were given regular auscultation intubation, and finally the bronehoscope was used to accurately locate the patients. The patients in the observation group were treated with double-lumen bronchus catheterization guided by fiberoptic bronchoscope. The success rate of the two groups of patients were analyzed, and the values of heart rate and mean arterial pressure were recorded at different time points. Results： The success rate of the observation group （95. 24% ） was higher than that of the control group （62.5%）, while tie positioning time was shorter（ P 〈 0.05 ）. During the operation, the heart rate and mean arterial pressure of the observation group were small; compared with those before and after intubation, P 〉 0.05. The heart rate and mean arterial pressure were significantly higher in the control group at the end of intubation; compared with those before and after intubation, P 〈 0.05 ; At the end of intubation, 3 min after intubation, the heart rate and mean arterial pressure in the observation group were lower than those in the control group （P 〈0.05 ） ; the incidence of hypoxemia in the observation group was significantly lower than that in the control group （ P 〉 0. 05 ）. The incidence of postoperative tracheal intubation complications in the observation group was not significantly different from that in the control group （P 〉 0.05）. Conclusion： The effect of double-lumen endobronchial catheterization guided by fiberoptic bronchoscope in thoracic surgical anesthesia is significant. It can be quickly and accurately positioned and the impact on the patient is small, which can help to ensure the smoothness of the operation and is worthy of popularization and application.