气管导管外放置Arndt支气管内阻断器用于婴幼儿单肺通气的效果

Efficacy of routine extraluminal use of Arndt endobronchial blocker for one-lung ventilation in infants

目的 评价气管导管外放置Arndt支气管内阻断器用于婴幼儿单肺通气的效果.方法 择期拟行胸腔镜手术婴幼儿30例,年龄6- 36月,ASA分级Ⅰ或Ⅱ级,体重5-18 kg.将Arndt 支气管内阻断器前端圈套绳套于气管导管前端,阻断器至于气管导管外备用.全麻诱导后,纤维支气管镜引导下置入Arndt支气管内阻断器.于阻断器置入前（T1）、阻断器置入时（T2）、单肺通气开始时（T3）、双肺通气开始时（T4）、气管拔管时（T5）记录MAP、HR、SpO2、PETCO2及气道压.记录阻断器置入时间及成功置入情况、肺萎陷时间,记录肺萎陷满意情况、阻断器移位、声嘶、术中心血管不良事件、单肺通气期间低氧血症和通气不足的发生情况.结果 与T1时比较,其余时点HR和MAP差异无统计学意义（P〉0.05）,T2,3时气道压升高,T4时PETCO2升高（P〈0.05）.阻断器置入时间（5.6＆#177;1.2） min,阻断器置入成功率93％,肺萎陷满意率83％,阻断器移位发生率为13％（均为右侧置入阻断器）,成功置入阻断器的患儿术中未见心血管不良事件、低氧血症和通气不足发生.结论 气管导管外放置Arndt支气管内阻断器可快速、有效、安全地用于婴幼儿单肺通气.

Objective To evaluate the efficacy of routine extraluminal use of an Arndt endobronchial blocker （AEB） for one-lung ventilation （OLV） in infants.Methods Thirty American Society of Anesthesiologists physical status Ⅰ or Ⅱ infants,aged 6-36 months,weighing 5-18 kg,undergoing elective thoracoscopic surgery,were enrolled in the study.The loop of AEB was fastened to the front of the endotracheal tube （ETT）,and the blocker was placed externally to the ETT.After induction of general anesthesia,the AEB＆#39;s placement was facilitated through the use of a fibreoptic bronchoscope.Mean arterial pressure,heart rate,end-tidal pressure of carbon dioxide,oxygen saturation and airway pressure were recorded before AEB placement （T1）,during AEB placement （T2）,at the beginning of OLV （T3）,at the beginning of two lung ventilation （T4） and at extubation （T5）.The AEB placement time and successful placement and lung collapse time were recorded.The satisfaction with lung collapse,AEB shifting,hoarseness and development of intraoperative adverse cardiovascular events and hypoxemia and hypoventilation during OLV were recorded.Results Compared with the baseline at T1,no significant change was found in heart rate or mean arterial pressure at the other time points （P〉 0.05）,airway pressure was significantly increased at T2,3,and end-tidal pressure of carbon dioxide was increased at T4 （P〈0.05）.The AEB placement time was （5.6＆#177; 1.2） min,the success rate of AEB placement 93%,the rate of satisfaction with lung collapse 83%,and the incidence of AEB shifting （only found in the pediatric patients in whom AEBs were placed on the right side） 13%.No intraoperative adverse cardiovascular events,hypoxemia or hypoventilation was observed in the pediatric patients in whom AEBs were successfully placed.Conclusion Routine extraluminal use of an AEB can provide a fast,safe and effective method for OLV in infants.