艾司氯胺酮雾化吸入联合I-gel喉罩和Wellead封堵器在单肺通气中的应用

Application of aerosol inhalation of esketamine combined with I-gel laryngeal mask and Wellead occluder in single lung ventilation

目的探讨艾司氯胺酮雾化吸入联合I-gel喉罩和Wellead支气管封堵器用于胸腔镜单肺通气手术中的有效性。方法选择拟行胸腔镜手术患者75例,男39例,女36例,年龄28~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组:艾司氯胺酮雾化吸入联合I-gel喉罩和Wellead支气管封堵器组(EW组)、I-gel喉罩联合Wellead支气管封堵器组(LW组)和气管导管联合Wellead支气管封堵器组(TW组),每组25例。记录三组置入时间、拔除时间、苏醒时间和单肺通气期间P_(ET)CO_(2)最高值。记录平卧位双肺通气15 min和侧卧位单肺通气15 min时的气道峰压(Ppeak)和动态肺顺应性(Cdyn),单肺通气前10 min(T_(0))、单肺通气后10(T_(1))、30(T_(2))、60 min(T_(3))和单肺通气结束(T_(4))时肺泡灌洗液肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)等炎性因子变化,手术侧肺萎陷评分,术后呛咳、声音嘶哑、咽喉疼痛和肺不张等发生情况。结果与TW组比较,EW组和LW组拔除时间和苏醒时间明显缩短(P<0.05),EW组双肺和单肺通气时Ppeak明显降低,Cdyn明显升高(P<0.05),LW组单肺通气时Ppeak明显降低,Cdyn明显升高(P<0.05),EW组和LW组T_(2)—T_(4)时TNF-α、IL-6和IL-8明显降低(P<0.05),呛咳、咽喉疼痛发生率明显降低(P<0.05)。与LW组比较,EW组双肺和单肺通气时Ppeak明显降低,Cdyn明显升高(P<0.05),T_(2)—T_(4)时TNF-α、IL-6和IL-8明显降低(P<0.05)。三组置入时间、P_(ET)CO_(2)最高值和肺萎陷评分差异无统计学意义,三组无一例发生肺不张。结论使用艾司氯胺酮雾化吸入联合I-gel喉罩和Wellead支气管封堵器进行胸腔镜手术单肺通气麻醉,能够保证手术期间所需的通气,明显减轻全麻诱导及苏醒期的气道刺激,减轻肺炎症反应,改善肺顺应性,值得临床推广使用。

Objective To investigate the effectiveness of esketamine aerosol inhalation combined with I-gel laryngeal mask and Wellead bronchial occluder for thoracoscopic single lung ventilation surgery.Methods Seventy-five thoracic surgery patients,39 males and 36 females,aged 28-64 years,BMI 18-25 kg/m^(2),ASA physical statusⅠorⅡ,were selected for thoracoscopic surgery.Patients were randomly divided into three groups by digital table method:esketamine nebulizing inhalation combined with I-gel laryngeal mask and Wellead bronchial sealer group(group EW),I-gel laryngeal mask combined with Wellead bronchial sealer group(group LW),and tracheal catheter combined with Wellead bronchial sealer group(group TW),25 cases in each group.The insertion time,extraction time,awakening time,and the highest P_(ET)CO_(2) value during single lung ventilation were recorded in the three groups.Airway peak pressure(Ppeak)and dynamic lung compliance(Cdyn)were recorded during 15 minutes of supine double-lung ventilation and 15 minutes of lateral single-lung ventilation.The changes of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8)and other inflammatory factors in alveolar lavage fluid at 10 minutes before single lung ventilation(T_(0)),10(T_(1)),30(T_(2)),60 minutes(T_(3))after single lung ventilation,and at the end of single lung ventilation(T_(4)),lung collapse score on the operative side,postoperative coughing,hoarseness,sore throat,and atelectasis occurred.Results Compared with group TW,the extraction time and awakening time of groups EW and LW were significantly shortened(P<0.05),Ppeak was significantly decreased and Cdyn was significantly increased in group EW during double lung and single lung ventilation(P<0.05),and Ppeak was significantly decreased and Cdyn was significantly increased in group LW during single lung ventilation(P<0.05),TNF-α,IL-6 and IL-8 were significantly decreased at T_(2)-T_(4) in groups EW and LW(P<0.05),and the incidence of cough and throat pain was significantly decreased(P<0.05).Compared with group LW,Ppeak and Cdyn were significantly decreased in group EW during double lung and single lung ventilation(P<0.05),and TNF-α,IL-6,and IL-8 were significantly decreased at T_(2)-T_(4)(P<0.05).There were no significant differences in the insertion time,the highest value of P_(ET)CO_(2) and the lung collapse score among the three groups,and no case of atelectasis occurred among the three groups.Conclusion The use of esketamine aerosol inhalation combined with I-gel laryngeal mask and Wellead bronchial occluder for thoracoscopic surgery can ensure the required ventilation during surgery,significantly reduce airway irritation during general anesthesia induction and recovery,reduce pneumonia reaction,and improve lung compliance,which is worthy of clinical promotion.