可视支气管堵塞器插管和可视双腔支气管导管插管的对比研究*

Comparative study of endobronchial tube blocker and visual double lumen bronchial tube intubation*

摘要:

比较可视支气管堵塞器（EBB）插管和可视双腔支气管导管（VDLT）插管在胸科手术中插管定位时间、单肺通气效果及对气道炎症应激反应的比较。方法 选择行胸腔镜肺叶切除术的患者40例，随机分为两组，分别用VDLT插管和EBB插管。比较两组的插管时间、定位时间、导管移位率，记录两组患者插管前（T0）、插管即刻（气管导管主套囊过声门的时间）（T1）、插管定位成功即刻（T2）和插管定位成功后5 min（T3）时引起的心率（HR）、平均动脉压（MAP）变化和插管前后血清去甲肾上腺素（NE）、血清皮质醇（Cor）和C反应蛋白（CRP）等炎症应激水平的变化，并进行对比，以及比较单肺通气后两组不同时间点肺萎陷的程度。结果 EBB组插管时间比VDLT组短，在T1和T2时刻，两组的HR和MAP相比差异有统计学意义，在T3时刻，两组患者炎症应激水平（NE、Cor和CRP）差异有统计学意义；VDLT组定位时间快于EBB组；两组导管移位率、纤维支气管镜（FOB）使用率、单肺通气后各时点肺萎陷的程度比较，差异无统计学意义。结论 EBB插管时间快、定位准确、插管刺激小，术中持续气道可视化管理方便，值得推广。

Abstract:

To compare endobronchial blocker tube intubation and visual double-lumen bronchial catheterization in intubation time, single-lung ventilation, and airway inflammatory stress response in thoracic surgery. Methods 40 patients underwent thoracoscopic lobectomy were randomly divided into two groups, which were intubated with a visual double-lumen bronchial catheter and a endobronchial blocker tube device. Intubation time, localization time, catheter transposition rate, and hemodynamic changes observed in the intubation (T0), immediate intubation (time of tracheal catheter main cuff transsexual door) (T1), successful intubation positioning (T2), 5 minutes after successful intubation positioning (T3) were compared between the two groups and changes in serum norepinephrine, serum cortisol and C-reactive protein levels before and after intubation. And the extent of lung collapse at different time points in the two groups after single lung ventilation. Results The intubation time of the endobronchial blocker tube group was shorter than that of the visual double-lumen bronchial catheter group, at T1 and T2, there was a statistically significant difference in heart rate and mean arterial pressure between the two groups, at T3, the difference in inflammatory stress levels (NE, Cor, and CRP) was statistically significant. Visible double-lumen bronchial catheter group positioning time is faster than endobronchial blocker tube group; the two groups of catheter displacement rate, fiberoptic bronchoscopy rate, lung collapse at each time after single lung ventilation has no difference in the degree of comparison. Conclusion The endobronchial blocker tube has fast intubation time, accurate positioning, small intubation stimulation, and convenient visualization and continuous airway management. It is worth of promoting.