气管导管外放置Arndt支气管内阻断器与二氧化碳人工气胸用于婴幼儿单肺通气的比较

Comparison of extraluminal use of the Arndt endobronchial blocker and CO2 artificial pneumothorax for one lung ventila-tion in infants and children

目的:比较气管导管外放置Arndt支气管内阻断器与CO 2人工气胸用于婴幼儿单肺通气的通气效果。方法:择期行胸腔镜手术的婴幼儿28例,年龄6~36个月,ASA分级Ⅰ、Ⅱ级。两组患儿在全身麻醉诱导后行Arndt支气管内阻断器或单腔支气管导管置入,术中根据需要行单肺通气。根据患侧肺萎陷方法不同按照随机数字表法分为两组(每组14例):Arndt支气管内阻断器组(A组)和CO 2人工气胸组(C组)。观察记录患儿插管前(T 1)、插管后(T 2)、单肺通气开始时(T 3)、单肺通气结束时(T 4)、拔管时(T 5)MAP、心率、气道压力(airway pressure,Paw)变化及术中重要时间点血气分析中PaO 2、PaCO 2情况。记录、肺萎陷程度、单肺通气时间、拔管时间及术中低氧情况(SpO 2低于90%)。结果:所有患儿均顺利完成手术。A组T 2、T 4、T 5时MAP及T 4、T 5时Paw高于C组(P<0.05),T 3时点的Paw低于C组(P<0.05)。A组肺萎陷即刻评分、肺萎陷20 min评分高于C组(P<0.05)。两组患儿心率、PaCO 2、PaO 2、单肺通气时间、拔管时间及低氧发生率差异无统计学意义(P>0.05)。A组患儿有1例导管移位导致低氧,C组有2例患儿由于长时间胸腔压力过大导致低氧发生,均未导致严重不良后果。结论:气管导管外放置Arndt支气管内阻断器相比CO 2人工气胸应用于婴幼儿单肺通气时,患侧肺萎陷效果更佳,血流动力学更稳定。

Objective To compare the effects of extraluminal use of the Arndt endobronchial blocker and CO2 artificial pneu-mothorax for one lung ventilation in infants and children.Methods A total of 28 infants and children,aged from 6 to 36 months,American Society of Anesthesiologists(ASA)gradesⅠorⅡ,who were scheduled for thoracoscopy were selected.After induction of general anesthesia,they were placed with the Arndt endobronchial blocker or a single lumen tracheal tube,with one lung ventilation if needed during surgery.According to the differences in diseased lung collapse method,they were divided into two groups based on the random number table method(n=14):an Arndt endobronchial blocker group(group A)and a CO2 artificial pneumothorax group(group C).Then,we observed and recorded the changes of mean arterial pressure(MAP),heart rate,and airway pressure(Paw)before intuba-tion(T1),after intubation(T2),when one lung ventilation began(T3),when one lung ventilation ends(T4),and at the time of extubation(T5),and blood analysis was performed at important time points during surgery to measure arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbon dioxide(PaCO2).We also recorded lung collapse degree,one lung ventilation time,extubation time,as well as the condition of perioperative hypoxia(with less than 90%of SpO2).Results Operation was successfully finished in all pa-tients.Compared with group C,group A presented remarkable increases in MAP at T2,T4 and T5 and Paw at T4 and T5(P<0.05),as well as marked decreases in Paw at T3(P<0.05).Group A also showed higher scores of lung collapse immediately and over 20 min than group C(P<0.05).No statistical differences were found as to heart rate,PaCO2,PaO2,one lung ventilation time and hypoxia incidence between the two groups(P>0.05).There was one case of hypoxia due to tube displacement in group A.Two children in group C present-ed hypoxia due to excessive chest pressure for a long time.No serious adverse outcomes were found.Conclusions Compared with CO2 artificial pneumothorax,extraluminal use of the Arndt endobronchial blocker has better effects on lung collapse at the diseased side and more stable hemodynamics in infants and children with one lung ventilation.