喉罩联合支气管封堵器全麻在胸腔镜单肺通气中的临床应用效果

Clinical application effect of general anesthesia with laryngeal mask and bronchial occluder in thoracoscopic single lung ventilation

目的探讨喉罩联合支气管封堵器全麻在胸腔镜单肺通气中的临床应用效果。方法选取2014年10月～2017年10月我院收治的94例胸腔镜单肺通气患者作为研究对象,采用随机数字表法分为两组,每组各47例。对照组实施气管导管联合支气管封堵器全麻,观察组实施喉罩联合支气管封堵器全麻,记录两组患者血流动力学指标的改变情况,并行肺萎陷评分,比较两组患者的苏醒状况、气道峰压及不良事件。结果观察组患者在T_2、T_3、T_4时的心率低于对照组(P<0.05);观察组患者在T_2、T_3、T_4时的平均动脉压低于对照组(P<0.05);观察组患者的拔管时间、自主呼吸时间、睁眼时间早于对照组(P<0.05);观察组患者的肺萎陷评分高于对照组(P<0.05);两组患者不同时间点(单肺通气前、单肺通气中、单肺通气后)的气道峰压比较,差异无统计学意义(P>0.05);观察组患者的不良事件(声音嘶哑、咽喉疼痛、呛咳、吞咽困难)发生率低于对照组(P<0.05)。结论喉罩联合支气管封堵器全麻可用于胸腔镜单肺通气,具有良好的气道密闭性,可提高患者的通气效果,值得临床推广使用。

Objective To investigate clinical application effect of general anesthesia with laryngeal mask and bronchial occluder in thoracoscopic single lung ventilation. Methods A total of 94 patients with thoracoscopic single lung ventilation treated in our hospital from October 2014 to October 2017 were selected as the subjects, and divided into two groups by random number table method, with 47 cases in each group. The control group treated general anesthesia with tracheal catheter and bronchial occluder. The observation group treated general anesthesia with laryngeal mask and bronchial occluder. The changes of hemodynamic parameters were recorded in two groups. Pulmonary collapse scores were evaluated, and the recovery, peak airway pressure, adverse events were compared between two groups. Results The heart rate in observation group was lower than that in the control group at T2, T3, T4 (P<0.05). Mean arterial pressure in observation group was lower than that in the control group at T2, T3, T4 (P<0.05). The extubation time, spontaneous breathing time, eye opening time in observation group were earlier than those in the control group (P<0.05). The pulmonary collapse score in observation group was higher than that in the control group (P<0.05). There were no significant differences in peak airway pressure between two groups at different time points (before single lung ventilation, during single lung ventilation, after single lung ventilation)(P>0.05). The incidences of adverse events (hoarseness, throat pain, cough, dysphagia) in observation group were lower than those in the control group (P<0.05). Conclusion General anesthesia with laryngeal mask and bronchial occluder can be used in thoracoscopic single lung ventilation, which has good airway tightness and can improve ventilation effect of patients. It is worthy of clinical application.