可视双腔气管导管在单肺通气中的应用

Application of visual double-lumen tracheal tube in single lung ventilation

目的探讨可视双腔气管导管在单肺通气中的应用价值。方法选取2018年1月至2020年1月河南省人民医院需行单肺通气的胸外科择期手术患者60例,随机数字表法分为两组,每组30例。对照组采取传统双腔气管插管操作,观察组采取可视双腔气管导管。比较两组操作时间、插管情况、麻醉诱导前(T0)、诱导后插管前(T1)、双腔气管导管进入左侧支气管即刻(T2)、插管后(T3)心率(HR)、平均动脉压(MAP)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、血氧饱和度(SaO2)、局部脑氧饱和度(rSO2)。应用SPSS 22.0统计软件进行数据分析。结果观察组声门显露时间[(36.65±13.17) s]、气管插管时间[(130.55±27.69) s]短于对照组[(74.82±14.25)、(187.62±29.15) s,t=10.774、7.775,P<0.05];观察组首次插管成功率(96.67%)高于对照组(70.00%),甲状软骨按压率(3.33%)、术中气管导管异位重新定位率(0)、因重新定位气管插管导致低氧血症率(0)低于对照组(30.00%、23.33%、20.00%,χ2=7.680、7.680、5.822、4.630,P<0.05);观察组T1、T2、T3时刻HR、MAP波动小于对照组(t=0.013、3.143、3.093、2.822、2.669、2.085,P<0.05);插管后即时观察组PaCO2(33.79±2.46) mmHg(1 mmHg=0.133 kPa)低于对照组[(36.18±2.37) mmHg,PaO2(85.76±7.39) mmHg、SaO2(98.47±0.54)%]高于对照组[(80.34±6.80) mmHg、(97.06±0.42)%,t=3.832、2.956、11.289,P<0.05];观察组T2、T3时刻rSO2分别为(66.16±5.04)%、(64.33±6.19)%,高于对照组[(63.59±4.61)%、(60.18±5.92)%,t=2.061、2.654,P<0.05]。结论可视双腔气管导管应用于单肺通气患者,能缩短操作时间,提高操作成功率,降低低氧血症率,减小血流动力学波动,改善局部脑氧饱和度。

Objective:To explore the application value of visual double-lumen tracheal catheter in single lung ventilation.Methods:From January 2018 to January 2020,60 patients with elective thoracic surgery who needed single lung ventilation in Henan Provincial People’s Hospital were selected and divided into 2 groups with random number table method,30 cases in each group.The control group was given the traditional double-lumen endotracheal intubation,and the observation group underwent the visual double-lumen endotracheal tube.The operative time,intubation situation,heart rate(HR),mean arterial pressure(MAP)before induction of anesthesia(T0),before intubation(T1)after induction,immediately after the dual-lumen endotracheal tube entered the left bronchus(T2),after intubation(T3),arterial partial pressure of carbon dioxide(PaCO 2),arterial partial pressure of oxygen(PaO 2),blood oxygen saturation(SaO 2),and regional cerebral oxygen saturation(rSO 2)were compared between the two groups.Results:The glottal exposure time(36.65±13.17)s and tracheal intubation time(130.55±27.69)s of the observation group were shorter than those of the control group(74.82±14.25)s and(187.62±29.15)s(t=10.774,7.775,P<0.05);the first intubation success rate(96.67%)of the observation group was higher than that of the control group(70.00%),and the compression rate of thyroid cartilage(3.33%),intraoperative repositioning rate of tracheal tube ectopic(0),and hypoxemia rate due to repositioning of tracheal intubation(0)were lower than the control group(χ2=7.680,7.680,5.822,4.630,30.00%,23.33%,20.00%,P<0.05);the fluctuations of HR and MAP at T1,T2,and T3 in the observation group were smaller than those in the control group(t=0.013,3.143,3.093,2.822,2.669,2.085,P<0.05);immediately after intubation,PaCO 2(33.79±2.46)mmHg(1 mmHg=0.133 kPa)in the observation group was lower than that in the control group(36.18±2.37)mmHg,PaO 2(85.76±7.39)mmHg and SaO 2(98.47±0.54)%were higher than those of the control group(80.34±6.80)mmHg and(97.06±0.42)%(t=3.832,2.956,11.289,P<0.05);the rSO 2 at T2 and T3 in the observation group were(66.16±5.04)%and(64.33±6.19)%,respectively,which were higher than(63.59±4.61)%and(60.18±5.92)%in the control group(t=2.061,2.654,P<0.05).Conclusion:The visible double-lumen endotracheal tube is applied to patients with one-lung ventilation,which can shorten the operation time,increase the success rate of the operation,reduce the rate of hypoxemia,reduce hemodynamic fluctuations,and improve local cerebral oxygen saturation.