选择性肺叶封堵在肺功能障碍患者胸科手术中的应用

Application of Selective Pulmonary Lobar Occlusion in Thoracic Surgery for Patients With Pulmonary Dysfunction

目的对肺功能障碍患者胸科手术进行选择性肺叶封堵观察对氧合指数及气道压的影响。方法 2018年1月—2019年12月对患有肺大泡等疾病需行左下或左上肺以及右中或右下肺楔形切除的患者30例。术前肺功能状况通气储备百分比(MVV%)<60%,FEV1> 50%排除湿肺,有严重肝肾心以及其他系统严重疾病患者。随机分为两组,双腔导管插管(对照组)与支气管封堵器(观察组),每组15例。支气管封堵器进行选择性肺叶封堵左下肺或右下肺。双肺通气(T0),单肺通气(T1)30 min、单肺通气1 h(T2)、术后1 h(T3)、术后2 h(T4)分别测定两组患者动脉血气,并据此计算氧合指数(OI)。结果氧合指数在T1-T3时刻OI双腔导管组低于选择性肺叶封堵组,差异具有统计学意义(P <0.05)。对照组各时点气道压变化情况高于选择性肺叶封堵组(P <0.05)。结论在对肺功能障碍患者行胸手术中,采用支气管封堵器进行选择性肺叶隔离方式,减少了肺内分流。它可以较好地减轻肺损伤提高氧合。

Objective To observe the effect of selective pulmonary lobe occlusion on oxygenation index and airway pressure in patients with pulmonary dysfunction in thoracic surgery. Methods From January 2018 to December 2019, 30 patients with bullae needed wedge resection of the lower or upper left lung and the right middle or lower right lung. Preoperative lung function status: ventilate reserve percentage(MVV%), < 60%, FEV1 > 50% excluded wet lung, patients with severe liver, kidney, heart and other serious systemic diseases. They were randomly divided into two groups: double-lumen catheter(control group) and bronchial occluder(observation group), with 15 patients in each group. Bronchial occluder to selectively block the left lower lung or the right lower lung. Arterial blood gas of patients in the two groups was measured by doublelung ventilation(T0), single-lung ventilation(T1) for 30 min, single-lung ventilation for 1 h(T2), postoperative 1 h(T3), and postoperative 2 h(T4), respectively, and the oxygenation index(OI) was calculated accordingly. Results The oxygenation index in the OI double-cavity catheter group was lower than that in the selective pulmonary lobe occlusion group at T1-T3, which was statistically significant(P < 0.05). The changes of airway pressure at each time point in the double-cavity catheter group were higher than those in the observation group(P < 0. 05). Conclusion In the chest operation for patients with pulmonary dysfunction, the selective pulmonary lobe isolation with bronchial occlusive device can significantly reduce intrapulmonary shunt. It can reduce lung injury and improve oxygenation.