支气管封堵器与双腔支气管导管对开胸前肺萎陷影响的比较
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浙江大学医学院附属金华医院(金华市中心医院) 麻醉科,浙江 金华 321000

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浙江省科技厅公益技术应用研究项目(No:LGF19H010008);浙江省医药卫生科技计划项目(No:2019RC301);金华市科技局重点项目(No:2018-3-005)


Comparison of the effect between bronchial blocker and double-lumen endotracheal tube on pre-thoracotomy lung collapse in thoracoscopic surgery
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Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine (Jinhua Municipal Central Hospital), Jinhua, Zhejiang 321000, China

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    摘要:

    目的 比较支气管封堵器(BB)与双腔支气管导管(DLT)对开胸前肺萎陷效果的影响。方法 选取择期行电视胸腔镜下左肺叶切除术的患者72例,采用随机数表法分为3组(n = 24):DLT常规萎陷组(DLT组)、DLT开胸前肺萎陷技术组(PTLCT-DLT组)和BB开胸前肺萎陷技术组(PTLCT-BB组)。其中,PTLCT-DLT组和PTLCT-BB组中分别有2例和1例发生低氧血症[经皮动脉血氧饱和度(SpO2) < 90%],被剔除,最终DLT组24例、PTLCT-DLT组22例、PTLCT-BB组23例完成该项研究。DLT组右侧卧位前左通道被夹闭并向空气开放,PTLCT-DLT组双肺纯氧通气并在侧卧位前夹闭左通道,PTLCT-BB组在侧卧位前封堵左支气管,排气管被故意堵塞。比较3组患者侧卧位即时(T1)、单肺通气8 min(T2)、单肺通气10 min(T3)和开胸后2 min(T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)、SpO2和动脉血氧分压(PaO2),记录3组患者在胸腔镜置入即刻的肺萎陷评分(LCS)。结果 与DLT组比较,PTLCT-DLT组和PTLCT-BB组的LCS明显升高(P < 0.05),PTLCT-DLT组与PTLCT-BB组比较,差异无统计学意义(P > 0.05)。在T3时点,PTLCT-DLT组和PTLCT-BB组SpO2较DLT组明显降低(P < 0.05),PTLCT-DLT组和PTLCT-BB组在T2和T3时点PaO2较DLT组明显降低(P < 0.05),在T4时点较DLT组明显升高(P < 0.05)。结论 开胸前肺萎陷技术有助于BB和DLT完成开胸前肺萎陷,两者对开胸前肺萎陷的影响无差异。

    Abstract:

    Objective To compare the effect of bronchial blocker (BB) and double-lumen endotracheal tube (DLT) on pre-thoracotomy lung collapse in thoracoscopic surgery.Methods 72 patients underwent elective thoracoscopic left lung surgery, were randomly divided into 3 groups (n = 24): double-lumen endotracheal tube group (DLT group), DLT with PTLCT group (PTLCT-DLT group) and bronchial blocker with PTLCT group (PTLCT-BB group). Two patients in group PTLCT-DLT and one patient in group PTLCT-BB group were excluded due to hypoxemia [(percutaneous arterial oxygen saturation, SpO2) < 90%)]. Eventually, 24 patients in the DLT group, 22 patients in the PTLCT-DLT group, and 23 patients in the PTLCT-BB group completed. The left channel was clamped and opened to air before right lateral position in DLT group. Patients in the PTLCT-DLT were treated by using the double lung ventilation with FiO2 = 1.0 and the left channel was blocked before changing into the lateral position. In the PTLCT-BB group, the operative bronchus was blocked before changing into the lateral position, and the BB suction tube was intentionally blocked.Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), SpO2, and arterial partial pressure of oxygen (PaO2) were recorded in each group at the following four time points: immediately in lateral position (T1), one-lung ventilation 8 min (T2), one-lung ventilation 10 min (T3), 2 min after pleura opening (T4). The operated lung was evaluated using lung collapse scale (LCS) immediately after opening the pleura.Results Compared with DLT group, the LCS of PTLCT-DLT group and PTLCT-BB group were significantly increased (P < 0.05), and there was no significant difference in LCS between the PTLCT-DLT group and PTLCT-BB group (P > 0.05). At T3, compared with DLT group, the SpO2 of PTLCT-DLT group and PTLCT-BB group were significantly decreased (P < 0.05). Compared with DLT group, the PaO2 of PTLCT-DLT group and PTLCT-BB group were significantly decreased at T2 and T3 (P < 0.05) and were significantly increased at T4 (P < 0.05).Conclusion PTLCT can helps BB and DLT to complete the pre-thoracotomy lung collapse, there was no difference in the effect of the two on pre-thoracotomy lung collapse.

    表 1 3组患者一般资料比较Table 1 Comparison of general data among the three groups
    图1 研究对象筛选流程图Fig.1 Flow chart of subject selection
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赵栋,杨娜,熊畅,王晨,蓝志坚,许多嘉.支气管封堵器与双腔支气管导管对开胸前肺萎陷影响的比较[J].中国内镜杂志,2022,28(7):14-20

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  • 收稿日期:2021-09-15
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  • 在线发布日期: 2022-08-12
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