可视双腔支气管导管在麻醉科住院医师实施肺隔离技术的应用

Application of VivaSight double lumen tube of lung isolation in anesthesia residents

目的本研究观察可视双腔支气管导管(double lumen tube,DLT)对麻醉科住院医师实施肺隔离技术成功率的影响。方法本院择期行胸腔镜下肺部手术,且均需在全麻下行DLT插管实施肺隔离技术的患者60例,男35例,女25例,年龄18~75岁,BMI 18~30 kg/m 2,ASAⅠ—Ⅲ级,随机分为可视DLT组(可视组)和普通DLT组(传统组),每组30例。招募5位麻醉科住院医师和1位麻醉科副主任医师参与本次研究。5位麻醉科住院医师经副主任医师培训后,在其监督指导下应用可视DLT和传统DLT结合纤维支气管镜辅助定位。记录麻醉科住院医师在双腔管置管过程中的目标支气管到位率以及成功定位DLT所需的时间;记录患者术后咽痛、声音嘶哑和术后呛咳的发生情况。结果可视组的目标支气管到位率明显高于传统组(93.3%vs.43.3%)(P<0.01),且成功定位DLT所需的时间明显短于传统组(P<0.01)。可视组患者术后咽痛发生率较传统组明显减少(23.3%vs.50.0%)(P<0.05)。结论与传统DLT比较,可视DLT提高麻醉科住院医师实施肺隔离技术的成功率,减少插管并发症,可作为临床实施肺隔离技术优选的气道管理设备。

Objective To observe the effect of VivaSight Double lumen tube(DLT)on the success rate of lung isolation implemented by anesthesia residents.Methods Sixty patients undergoing elective thoracoscopic lung surgery with double-lumen tube intubation under general anesthesia,35 males and 25 females,aged 18-75 yr,with a BMI 18-30 kg/m 2,falling into ASA physical statusⅠ-Ⅲcategory,were randomized into viva sight double lumen tube group(visual group)and common double lumen tube group(traditional group),30 patients in each.Five resident physicians and one deputy chief physician of anesthesiology participated in this study.After being trained by the deputy chief physician,the anesthesia residents used DLT and traditional DLT to implement lung isolation,under supervision of the deputy chief physician.The success rate at intubation and the time required to successfully locate the viva sight-DLT or traditional DLT were recorded.Postoperative sore throat,hoarseness and bucking were recorded.Results The success rate of target bronchus arrival in the visual group was significantly higher than that in the traditional group(93.3%vs.43.3%)(P<0.01),and the time required to successfully locate the DLT in the visual group was significantly shorter than that in the traditional group which used the traditional DLT(P<0.01).The incidence of postoperative sore throat was significantly lower in the visual group than that in the traditional group(23.3%vs.50.0%)(P<0.05).Conclusion DLT improves the success rate of lung isolation implemented by anesthesia residents and reduce the complications of intubation,which can be used as at optimal airway management equipment for clinical lung isolation.