肺部超声与纤维支气管镜用于支气管封堵器定位的比较

Application of lung ultrasound and fiberoptic bronchoscopy in the positioning of endobronchial blocker

目的:比较肺部超声技术与纤维支气管镜用于支气管封堵器定位方面的优劣。方法:择期经左侧开胸行食管癌根治术患者90例,采用随机数字表法分为2组,每组45例。麻醉诱导后,经口插入7.5#加强型气管导管,之后采用盲法放置支气管封堵器至一侧支气管。2组患者分别采用肺部超声检查(L组)和纤维支气管镜检查(B组)方法定位封堵器位置并判断肺隔离效果,确定套囊位置良好后,摆放右侧卧位,之后再次判断肺隔离情况。记录L组和B组2次判断肺隔离情况所需要的总时间、术中封堵器调整的次数、术中肺萎陷满意度评分以及患者2次定位前及定位过程中的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)及气道峰值压(peak airway pressure,PAW)的水平。结果:L组和B组确定肺隔离时间、肺萎陷满意度评分术中套囊调整次数差异无统计学意义(P>0.05)。L组2次判断肺隔离时的HR、MAP及PAW较判断前无明显变化(P>0.05),B组2次判断肺隔离时的HR、MAP及PAW明显高于纤维支气管镜置入前(P<0.05)。结论:肺部超声判断支气管封堵器肺隔离效果与纤维支气管镜相近,但肺部超声对血流动力学的影响小于纤维支气管镜。

Objective:To compare the advantages and disadvantages of pulmonary ultrasound and fiberoptic bronchoscopy in the localization of endobronchial blocker.Methods:90 patients undergoing elective left thoracotomy for esophageal cancer were randomly divided into two groups:with 45 in each.After anesthesia induction,7.5 cm reinforced tracheal tube was inserted orally,and then the endobronchial blocker was placed blindly to the unilateral bronchus.The position of blocker was located and the effect of pulmonary isolation was judged respectively by pulmonary ultrasonography(group L)and fiberoptic bronchoscopy(group B).Patients were placed in right lateral position and then the blocker position was judged again.The total time needed to judge the pulmonary isolation in group L and group B,the times of intraoperative blocker adjustment,the satisfaction score of intraoperative pulmonary collapse,and the levels of MAP,HR and peak airway pressure(PAW)before and during the two positioning were recorded.Results:There was no significant difference in lung isolation time,lung collapse satisfaction score and intraoperative cuff adjustment times between group L and group B(P>0.05).Compared with those before positioning,HR,MAP and PAW in group L during the blocker localization had no significant changes(P>0.05).The levels of HR,MAP and PAW in group B during twice blocker positioning were significantly higher than those before fiberoptic bronchoscope implantation(P<0.05).Conclusion:The pulmonary isolation effect of endobronchial blocker judged by pulmonary ultrasound is similar to that of fiberoptic bronchoscope,but the effect of pulmonary ultrasound on hemodynamics is less than that of fiberoptic bronchoscopy.