小号左侧双腔气管导管复合小潮气量通气在胸科手术中的初步应用

The application of small-sized left-sided double-lumen tube to thoracic surgery when combined with low tidal volume ventilation

目的探讨小号左侧双腔气管导管复合小潮气量通气用于胸科手术麻醉的可行性。方法选择2016年8月~2017年2月南京市第一医院需放置左侧双腔气管导管行单肺通气的30例胸科手术患者作为研究对象,采用随机数字表法分为两组,每组各15例。两组患者分别应用不同型号的左侧双腔气管导管:实验组(T组)应用小型号,男应用F35号,女应用F32号;对照组(C组),男应用F37号,女应用F35号。比较两组患者气管插管时的插管阻力、纤维支气管镜检查所见呼吸道损伤情况、插管次数;比较两组患者插管成功开始双肺通气时、单肺通气开始时和单肺通气1 h的呼吸道峰压与单肺通气1 h的血氧饱和度(SPO_2);记录气管插管前平均动脉压(MAP)的最低值及其对应的心率(HR)、气管插管后MAP的最高值及其对应的HR,以后者减去前者计算插管所致的MAP和HR增加值并进行比较。结果 T组气管插管时的插管阻力和纤维支气管镜检查呼吸道损伤发生率均低于C组,差异有统计学意义(P<0.05);两组插管次数比较,差异无统计学意义(P>0.05)。机械通气期间,两组插管成功开始双肺通气时、单肺通气开始时、单肺通气1 h的呼吸道峰压和单肺通气1 h的SPO_2比较,差异无统计学意义(P>0.05)。此外,T组气管插管所致的HR增加值显著小于C组(P<0.05),MAP增加值低于C组(P<0.05)。结论复合小潮气量机械通气时,小号左侧双腔气管导管能够满足术中单肺通气的需要,且气管插管所致的呼吸道损伤更轻、血流动力学更平稳。

Objective To study the feasibility of small-sized left-sided double-lumen tube for thoracic surgery anesthesia when combined with low tidal volume ventilation. Methods From October 2016 to February 2017, 30 cases of thoracic surgery patients with a single lung ventilation in the left-sided double-lumen tube in Nanjing First Hospital were selected as research objects, and divided into two groups by random number table, with 15 cases in each group.Patients of two groups were treated with different size left-sided double-lumen tubes. The trial group（group T） was applied to the small model, male application F35, female application F32. Control group（group C） was applied to the normal model, male application F37, female application F35. The resistance during intubating, airway trauma testified through fiberoptic bronchoscopy, intubation attempts and hemodynamic changes following intubation were compared between two groups. The airway peak-pressures at the beginning of double-lung ventilation following successful intubation and one-lung ventilation, together with the airway peak-pressure after one-hour′s one-lung ventilation, the oxygen saturation（SPO2） after one-hour′s one-lung ventilation were also compared between two groups. The lowest mean arterial pressure（MAP） and corresponding heart rate（HR） before intubation, the highest MAP and corresponding HR after intubation were recorded. The deviation value between the highest MAP and the lowest MAP, together with the corresponding deviation value of HR, were also compared between group T and group C. Results The resistance during intubating, airway trauma testified through fiberoptic bronchoscopy in group T were lower than those of group C, with statistically significant difference（P〈0.05）. There was no statistical difference between two groups in intubation attempts（P〈0.05）. During mechanical ventilation, there was no statistical difference between two groups in the double-lung ventilation following succ essful intubation,one-lung ventilation together with the airway peak-pressure after one-hour ′ s one-lung ventilation, SPO2 after one-hour′s one-lung ventilation（P〈0.05）. In addition, the increased value of HR caused by intubation was less in groupT than in group C（P〈0.05） and the increased value of MAP was also less in group T than in group C（ P〈0.05）.Conclusion Small-sized left-sided double-lumen tube can satisfy the need of one-lung ventilation when combined with low tidal volume ventilation, and the respiratory tract injury caused by tracheal intubation was more stable.