支气管堵塞器在达芬奇机器人胸腺瘤切除术中的应用

Application of Bronchial Plug in Da Vinci Robot Thymoma Resection

目的:观察支气管堵塞器在达芬奇机器人系统(RATS)胸腺瘤切除术中的临床应用效果。方法:采用回顾性研究方法,筛选2018年1月至2019年4月期间在我院择期行胸腺瘤切除术的48例患者纳入本实验,根据气管插管方法不同将其分为双腔支气管导管组(DLT组,n=24)和支气管堵塞器组(BBs组,n=24),两组患者的麻醉方法、手术方法基本相同,记录两组患者的手术时间、单肺通气时间、气管插管及定位时间、操作成功率、肺萎陷优良率、导管异位率,记录单肺通气前(T1)、单肺通气后10min(T2)、单肺通气后60min(T3)、恢复双肺通气后10min(T4)四个时间点的气道峰压(Ppeak)、PO2、PCO2,记录术后声音嘶哑、咽喉疼痛并发症的发生率。结果:两组患者的插管成功率和肺萎陷满意率比较差异无统计学意义(P均>0.05),BBs组的插管时间和肺萎陷时间长于DLT组(P均<0.05),侧卧位移管率高于DLT组(P<0.05);BBs组在T2、T3时刻的Ppeak值低于DLT组(P均<0.05),但两组患者在T1、T2、T3、T4时刻的PO2、PCO2比较差异无统计学意义(P均>0.05);BBs组的术后声嘶、咽痛发生率低于DLT组(P均<0.05)。结论:在达芬奇机器人胸腺瘤切除术中,支气管堵塞器具有气道阻力低、术后咽痛发生率低的优势,患者的舒适性更高,但肺萎陷时间更长,与双腔支气管导管比较,两组效果类似,各有优势。

Objective:To observe the clinical effect of bronchial occluder in Thymectomy with the robot system of Leonardo da Vinci(rats).Methods:48 patients who underwent thymectomy in our hospital from January 2018 to April 2019 were selected and included in this study.According to the different intubation methods,they were divided into two groups:double lumen endotracheal tube group(DLT group,n=24)and bronchial occluder group(BBS group,n=24).The anesthesia and operation methods of the two groups were basically the same,and the hands of the two groups were recorded The peak airway pressure(ppeak),PO2 and PCO2 were recorded at four time points before one lung ventilation(T1),10 minutes after one lung ventilation(T2),60 minutes after one lung ventilation(T3),and 10 minutes after two lung ventilation(T4),respectively.The voice hoarseness and throat pain and the incidence of complications were recorded.Results:There was no significant difference in the success rate of intubation and satisfaction rate of pulmonary collapse between the two groups(P>0.05).The intubation time and pulmonary collapse time of BBS group were longer than those of DLT group(P<0.05),and the rate of lateral displacement tube was higher than that of DLT group(P<0.05).The peak value of BBS group at T2 and T3 was lower than that of DLT group(P<0.05),but the pO2 and PCO2 of the two groups at T1,T2,T3 and T4 were poor The incidence of hoarseness and pharyngeal pain in BBS group was lower than that in DLT group(P<0.05).Conclusion:In Da Vinci's robotic thymectomy,the bronchial occluder has the advantages of low airway resistance and low incidence of postoperative pharyngeal pain.The patient's comfort is higher,but the time of lung collapse is longer.Compared with the double lumen bronchial tube,the two groups have similar effects and advantages.