小儿胸腔镜手术中选择性肺叶支气管阻断与主支气管阻断的比较:一项回顾性队列研究

Comparison of selective lobobronchial block and main bronchial block in thoracoscopic surgery in children:a retrospective cohort study

目的探究小儿胸腔镜手术中选择性肺叶支气管阻断与主支气管阻断的差异。方法采取回顾性队列研究,分析2019年12月至2022年12月在河南省儿童医院郑州儿童医院收治的接受胸腔镜手术治疗的150例患儿临床资料,其中80例采用选择性肺叶支气管阻断作为研究组,70例行常规主支气管阻断的患儿作为对照组。对比两组患儿一般资料中年龄、性别、体质量、手术时间等资料,比较两组低氧血症、肺塌陷程度、肺不张、支气管阻断器移位次数,对比两组不同时点[单肺通气(OLV)前(T1)、OLV 10 min后(T2)、OLV结束后10 min(T3)]心率(HR)、平均动脉压(MAP)、肺塌陷程度、气道压力(PAW)、肺泡动脉氧分压(AaDO2)水平差异。结果研究组患儿低氧血症、支气管阻断器移位发生率及肺不张情况比较,组间差异有统计学意义(P<0.05)。重复测量方差结果表明,两组患儿不同时点HR、MAP水平以时间因素为源的主体间效应比较差异有统计学意义(P<0.05)。重复测量方差结果表明,两组患儿不同时点PAW、AaDO2水平以时间因素为源、以组别为源的主体间效应及以时间与组别交互为源的主体内效应间比较差异有统计学意义(P<0.05)。研究组T2、T3时点PAW、AaDO2水平均显著低于对照组,组间差异均有统计学意义(P<0.05)。结论小儿胸腔镜手术中使用选择性肺叶支气管阻断效果理想,能够有效改善患儿通气及相关氧合情况,减少肺不张、低氧血症等并发症的发生。

Objective To explore the difference between selective lobar bronchial block and main bronchial block in thoracoscopic surgery in children.Methods A retrospective cohort study was conducted to analyze the clinical data of 150 children undergoing thoracoscopic surgery admitted to Henan Children's Hospital,Zhengzhou Children's Hospital,and Children's Hospital Affiliated to Zhengzhou University from December 2019 to December 2022.In the examination of the electronic medical record,80 children were found to have selective lobar bronchial block,which was used as the study group,and 70 children were matched as the control group.Compare the general data of children in the two groups,such as age,gender,weight,surgical time,and other data.Compare the two groups with respect to hypoxemia,degree of pulmonary collapse,atelectasis,and number of bronchial blocker shifts.Compare the heart rate(HR),mean arterial pressure(MAP),degree of pulmonary collapse,and airway pressure(PAW)at different time points in the two groups[before single lung ventilation(OLV)(T1),10 min after OLV(T2),and 10 min after OLV(T3)]Difference in alveolar arterial oxygen partial pressure(AaDO2)levels.Results Comparison of the incidence of hypoxemia,bronchial blocker displacement,and atelectasis in children in the study group were statistically significant(P<0.05).The results of repeated measurement of variance showed that there was statistically significant difference in the inter subject effects of HR and MAP levels at different time points between the two groups based on time factors(P<0.05).The results of repeated measurement of variance showed that there was statistical significance between the inter-subjective effects of the levels of PAW and AaDO2 at different time points of the two groups with time factor as the source,group as the source,and intra-subjective effects with time and group interaction as the source(P<0.05).The levels of PAW and AaDO2 in the study group at time points T2 and T3 were significantly lower than those in the control group,and the differences between the groups were statistically significant(P<0.05).Conclusion The effect of selective lobobronchial blockade in thoracoscopic surgery in children is ideal,which can effectively improve the ventilation and related oxygenation of children,and reduce the occurrence of complications such as atelectasis and hypoxemia.