目的 比较纤维支气管镜(fiberoptic bronchoscope,FOB)引导硅胶型双腔支气管导管(double-lumen endotracheal tubes,DLT)与聚氯乙烯支气管封堵管(single-lumen tube with bronchial blocker,BB)插管在肺隔离手术中的应用效果。方法 选择2019-01至2020-12在河北医科大学附属秦皇岛市第一医院行肺隔离手术的患者102例,随机分为双腔支气管导管组(D组)和支气管封堵管组(B组),每组51例,实施左侧双腔管支气管插管术和左侧单腔管封堵术,均在FOB引导下完成气管插管及对位。记录两组气管插管时间、导管对位时间、导管错位发生率、术中肺最大程度塌陷所需时间、肺塌陷质量、单肺通气后动脉血二氧化碳分压(PaCO2)和呼气末二氧化碳分压(PetCO2)值、术后咽痛VAS评分及声带损伤程度。结果 气管插管时间、术后咽痛VAS评分、声带损伤发生率等,两组比较差异无统计学意义(P＞0.05);D组导管对位时间[(26.83±6.71)s]短于B组[(49.17±7.14)s],D组导管错位发生率(3.92%)低于B组(17.65%),D组术中肺最大程度塌陷所需时间[(11±5)s]短于B组[(31±17)s],D组肺塌陷质量(90.2%)优于B组(56.9%),单肺通气后PaCO2和PetCO2的差值小于B组,差异均具有统计学意义(P＜0.05)。结论 在需单肺隔离的手术中,FOB引导硅胶型DLT与BB一样快捷且损伤小,同时可以获得更佳的肺隔离效果。
Abstract
Objective To compare the application effect of silicone double-lumen endobronchial intubation and polyvinyl chloride(PVC) single-lumen tube with bronchial blocker intubation guided by fiberoptic bronchoscope (FOB) in lung isolation surgery. Methods One hundred and two patients admitted in the First Hospital of Qinhuangdao City from Januray 2019 to December 2020 were randomly divided into silicone double-lumen endobronchial tube group (group D,n=51) and PVC single-lumen tube with bronchial blocker group(group B,n=51).Endotracheal intubation and confirmation of proper position were performed in both groups under the guidance of fiberbronchoscope.The time of intubation and fibrobronchoscopy positioning, the incidence of misplacement, the time required for maximum intraoperative lung collapse, the degree of satisfaction of pulmonary atrophy, the difference between arterial partial pressure of carbon dioxide (PaCO2) and end-expiratory partial pressure of carbon dioxide (PetCO2) after one-lung ventilation, postoperative pharyngeal pain VAS score and the degree of vocal cord injury were recorded in both groups. Results There was no significant difference in the time of intubation, postoperative pharyngeal pain VAS score and the incidence of vocal cord injury between the two groups (P>0.05).The time of fibrobronchoscopy positioning of group D[(26.83±6.71)s] was shorter than that of group B[(49.17±7.14)s], the incidence of misplacement of group D(3.92%) was lower than that of group B(17.65%), the time required for maximum lung collapse of group D[(11±5)s] was shorter than that of group B[(31±17)s],the degree of satisfaction of pulmonary atrophy of group D(90.2%)was better than that of group B(56.9%), and the difference between PaCO2 and PetCO2 after single-lung ventilation was smaller than that of group B, with statistical significance (P<0.05). Conclusions In surgical procedures of single lung isolation, fiber bronchoscope-guided silicone double-lumen bronchial catheter which is less invasive is as quick as bronchial blocking tube, and can achieve better lung isolation effect.
关键词
硅胶型双腔支气管导管 /
支气管封堵管 /
纤维支气管镜 /
单肺隔离
Key words
silicone double-lumen tube /
bronchial blocker tube /
fiberoptic bronchoscopy /
one lung isolation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Abdelazeem A. Double lumen tube: size and insertion depth[J]. Saudi J Anaesth,2021,15(3): 280-282.
[2] Jeon J, Lee K, Ahn G, et al. Comparison of postoperative sore throat and hoarseness between two types of double-lumen endobronchial tubes: a randomized controlled trial[J].CardiothoracVasc Anesth, 2015,29:121-125.
[3] Campos J H, Kernstine K H. A comparison of a left-sided Broncho-Cath with the torque control blocker univent and the wireguided blocker[J].Anesth Analg,2003, 96(1): 283-289.
[4] Yuji Kamimura,Toshiyuki Nakanishi,Aiji Boku Sato, et al.Effects of the anesthesiologist′s experience on postoperative hoarseness after double-lumen endotracheal tube intubation: a single-center propensity score-matched analysis[J].BMC Anesthesiol,2020,20(1):278.
[5] Martin B B,Lee M A,Erin J, et al.Laryngeal injury and upper airway symptoms after endotracheal intubation during surgery: a systematic review and meta-analysis[J].Anesth Analg,2021, 132(4):1023-1032.
[6] 陈解元, 杨 威, 王 刚, 等. 右支气管封堵器在胸科单肺通气手术中的应用[J]. 中国临床解剖学杂志, 2016, 34(3): 348-351.
[7] 陈军伟. 盲探下支气管封堵器在胸科手术麻醉中的应用[J]. 河南医学研究, 2020, 29(5): 817-819.
[8] 黄 胜,欧 智,陈琦妮, 等. 单腔支气管导管联合支气管封堵器与双腔支气管导管在开胸手术患者单肺通气中应用效果的对比研究[J]. 实用心脑肺血管病杂志, 2019, 27(12):79-82.
[9] 梁 飞,郑 诗,李 俊,等. 可视单腔气管导管联合支气管封堵器在单肺通气手术中的应用[J]. 广东医学, 2019, 40(12):1791-1794.
[10] Young Y J, Jeong C Y, Yong P S,et al. Time to tracheal intubation over a fibreoptic bronchoscope using a silicone left double-lumen endobronchial tube versus polyvinyl chloride single-lumen tube with bronchial blocker: a randomized controlled non-inferiority trial[J]. J Thorac Dis, 2019,11(3): 901-908.
[11] Stephen R C,Brian J T,Javier H C,et al. Lung isolation in the patient with a difficult airway[J]. Anesth Analg,2018, 126(6):1968-1978.
[12] Taeha R,Eugene K,Jong H K, et al.Comparing the placement of a left-sided double-lumen tube via fiberoptic bronchoscopy guidance versus conventional intubation using a Macintosh laryngoscope, to reduce the incidence of malpositioning: study protocol for a randomized controlled pilot trial[J].BMC, 2019, 20(1): 51.
[13] 张 娜,刘洪珍,杨承祥,等.支气管堵塞器与双腔支气管导管在胸腔镜手术中的应用比较[J].广东医学, 2012,33(8):1163-1165.
[14] 肖亮灿,叶 升,许静红,等.对比分析支气管封堵器和双腔支气管导管对儿童单肺通气的影响[J].中山大学学报(医学科学版), 2012, 33(4): 544-548.
[15] 杨晓玫,方宁宁,易文波,等.双腔支气管导管与支气管封堵器进行单肺通气对PetCO2和PaCO2的影响[J].山东大学学报(医学版), 2015, 53(11): 77-79.
[16] James P,Daniel D S,Ari E, et al. End-tidal and arterial carbon dioxide gradient in serious traumatic brain injury after prehospital emergency anaesthesia: a retrospective observational study[J]. Emerg Med J,2020, 37(11):674-679.
[17] Savino S,Salvatore G,Dan Stieper K, et al. Physiological effects of two driving pressure-based methods to set positive end-expiratory pressure during one lung ventilation[J].J Clin Monit Comput, 2021, 35(5):1149-1157.
[18] Oliver S,Fritz F,Robert S,et al. Transcutaneous PTCCO 2 measurement in combination with arterial blood gas analysis provides superior accuracy and reliability in ICU patients[J].J Clin Monit Comput, 2017, 31(1):153-158.
基金
秦皇岛市科技支撑计划项目(201902A169)
PDF(1319 KB)
