双腔气管导管和支气管封堵器在胸外科手术中的应用效果对比

Comparison of the application effect of double-lumen tracheal catheter and bronchial occluder in thoracic surgery

目的对比胸外科手术患者应用双腔气管导管、支气管封堵器实施肺隔离的效果。方法80例行胸外科手术的患者,按随机数字表法分为对照组和研究组,每组40例。对照组采取双腔气管导管隔离其肺,研究组患者利用支气管封堵器隔离其肺。比较两组患者相关临床指标(定位时间、插管时间、肺萎陷时间)、肺萎陷质量、并发症发生情况以及静脉血氧分压(PvO_(2))、动脉血氧分压(PaO_(2))、肺血分流率(Qs/Qt)、肺动态顺应性(CLdyn)水平。结果研究组手术过程中定位时间(4.26±0.57)min、插管时间(124.75±14.61)s均短于对照组的(6.89±0.85)min、(173.41±19.43)s,肺萎陷时间(8.21±1.01)min长于对照组的(5.82±0.77)min,差异有统计学意义(P<0.05)。两组肺萎陷优良率比较,差异无统计学意义(P>0.05)。研究组PvO_(2)(61.21±6.57)mm Hg(1 mm Hg=0.133 kPa)、PaO_(2)(185.32±22.65)mm Hg、Qs/Qt(19.24±4.37)%低于对照组的(68.49±6.43)mm Hg、(214.38±21.45)mm Hg、(23.87±4.52)%,CLdyn(35.89±5.74)ml/cm H2O(1 cm H_(2)O=0.098 kPa)高于对照组的(26.23±3.14)ml/cm H_(2)O,差异有统计学意义(P<0.05)。研究组患者的并发症发生率5.00%低于对照组的20.00%,差异有统计学意义(P<0.05)。结论胸外科手术患者采取双腔气管导管与支气管封堵器进行肺隔离各有优势,但支气管封堵器插管耗时较短,对患者下气道损伤也比较小,但其肺萎陷的时间则相对较长。

Objective To compare the effect of lung isolation with double-lumen tracheal catheter and bronchial occluder in patients with thoracic surgery.Methods 80 patients undergoing thoracic surgery were divided into a control group and a study group according to random number table,with 40 cases in each group.The control group received double-lumen tracheal catheter for lung isolation,and the study group received bronchial occluder for lung isolation.Both groups were compared in terms of relevant clinical indexes(positioning time,intubation time,lung collapse time),quality of lung collapse,occurrence of complications,venous oxygen partial pressure(PvO_(2)),arterial oxygen partial pressure(PaO_(2)),intrapulmonary shunt fraction(Qs/Qt),and dynamic lung compliance(CLdyn).Results The positioning time of(4.26±0.57)min and intubation time of(124.75±14.61)s in the study group were shorter than(6.89±0.85)min and(173.41±19.43)s in the control group;and the lung collapse time of(8.21±1.01)min was longer than(5.82±0.77)min in the control group.The difference was statistically significant(P<0.05).There was no significant difference in excellent rate of lung collapse between the two groups(P>0.05).The study group had PvO_(2)of(61.21±6.57)mm Hg(1 mm Hg=0.133 kPa),PaO_(2)of(185.32±22.65)mm Hg and Qs/Qt of(19.24±4.37)%,which were lower than(68.49±6.43)mm Hg,(214.38±21.45)mm Hg and(23.87±4.52)%in the control group;and CLdyn of(35.89±5.74)ml/cm H_(2)O(1 cm H_(2)O=0.098 kPa)was higher than(26.23±3.14)ml/cm H2O in the control group.The difference was statistically significant(P<0.05).The complication for lung isolation rate of the study group was 5.00%,which was lower than 20.00%of the control group,and the difference was statistically significant(P<0.05).Conclusion Both double-lumen tracheal catheter and bronchial occluder for lung isolation has its own advantages in patients with thoracic surgery,but the bronchial occluder has shorter intubation time and less damage to the lower airway,but the lung collapse time is relatively longer.