支气管封堵导管在胸腹腔镜联合食管癌根治术中的应用

Application of a new type of bronchial blocker in thoracolaparoscopic esophagectomy

目的评价支气管封堵导管在胸腹腔镜联合食管癌根治术中的安全性与有效性。方法选择2016年9月至2017年3月在本院胸外科择期行胸腹腔镜联合食管癌根治术的患者66例,采用抛硬币法将患者随机分为2组(n=33),支气管封堵导管组(BB组)和双腔支气管导管组(DLT组)。常规麻醉诱导后置入支气管封堵导管或双腔支气管导管。记录并比较两组患者麻醉诱导前(T_0)、诱导完成后3 min(T_1)、气管导管置入后即刻(T_2)和导管置入后3 min(T_3)的心率、平均动脉血压。比较两组患者在纤维支气管镜引导下导管的定位时间、左肺萎陷时间及萎陷效果;比较两组在气管导管位置确定后行双肺通气5 min时(T_4)、术中开始行单肺通气后10 min(T_5)、术毕由单肺通气转变为双肺通气后10 min(T_6)的气道峰压、呼吸频率和呼气末二氧化碳分压(P_(ET)CO_2),术中、术后低氧血症的发生率和术后患者的声嘶、咽痛发生率。结果在T_0、T_1和T_3时,两组患者心率、平均动脉压相似,差异无统计学意义(P>0.05);与DLT组比较,BB组T_2时的心率、平均动脉压均较低,差异有统计学意义(P<0.05);BB组定位时间明显缩短,萎陷时间明显增加,差异有统计学意义(P<0.05),但两组左肺萎陷程度评分差异无统计学意义(P>0.05);在T_4、T_5、T_6时间点,两组P_(ET)CO_2差异无统计学意义,BB组气道峰压均较DLT组明显降低(P<0.05);T_5时间点BB组呼吸频率较DLT组明显降低(P<0.05)。BB组术后声嘶和咽痛的发生率也较DLT组明显降低(P<0.05);两组患者术中、术后均未发生低氧血症。结论支气管封堵导管能够安全、有效地应用于胸腹腔镜联合食管癌根治术,为临床选择提供参考依据。

Objective To evaluate the safety and efficacy of a new type of bronchial blocker（ containing an endobronchial blocker and a single-lumen tube,made by Chengdu Chuanghua Sci Tech Co.Ltd） in the thoracolaparoscopic esophagectomy. Methods A total of 66 patients undergoing elective thoracolaparoscopic esophagectomy in our hospital from September 2016 to March 2017 were prospectively recruited in this study,and they were randomly divided into bronchial blocker group（ group BB,n = 33） and double-lumen tube group（ group DLT,n = 33）. After routine anesthetic induction,the bronchial blocker or double-lumen tube was inserted with the aid of video laryngoscopy. The heart rate and mean arterial pressure were recorded and compared before anesthesia induction（ T0）,3 min after anesthesia induction（ T1）,immediately after tracheal intubation（ T2） and 3 min after tracheal intubation（ T3）. The positioning time by fiberoptic bronchoscopy,collapse time of left lung and collapse effect were compared between the 2 groups.The peak airway pressure and end-tidal carbon dioxide partial pressure（ P（ET）CO2） were compared between the2 groups at the 2-lungs ventilation for 5 min after the tube position determined（ T4）,10 min after single lung ventilation（ T5） and 10 min after 2-lungs ventilation at the end of operation（ T6）. The incidence rate of intraoperative and postoperative hypoxemia,postoperative hoarseness and sore throat were also recorded.Results There were no significant differences in heart rate,mean arterial pressure between the 2 groups at the time points of T0,T1,and T3. Compared with group DLT,the heart rate and mean arterial pressure were significantly lower in group BB at T2（ P〈0. 05）. Group BB had significantly reduced positioning time,but lengthened collapse time（ P〈0. 05）. There was no significant difference in the degree of left lung collapse between the 2 groups（ P〈0. 05）. At T4,T5 and T6 points,there were no significant differences in the P（ET）CO2,and the group BB presented significantly reduced peak airway pressure（ P〈0. 05）. At T5,the respiratory rate of group BB was decreased significantly（ P〈0. 05）. The incidence rates of postoperative hoarseness and sore throat were significantly lower in the group BB than the group DLT（ P〈0. 05）. No hypoxemia case was observed in the 2 groups. Conclusion The bronchial blocker is safe and effective in thoracolaparoscopic esophagectomy,and should be applied as an option in clinical practice.