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

Comparison of the effect between bronchial blocker and double-lumen endotracheal tube on pre-thoracotomy lung collapse in thoracoscopic surgery

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.