Coopdech支气管阻塞导管在胸腔镜单肺通气手术中的应用

摘要

目的 观察Coopdech支气管阻塞导管用于胸腔镜手术实现单肺通气的效果.方法 选择单肺通气行胸腔镜手术患者50例,完全随机分为双腔支气管导管组(A组)和支气管阻塞导管组(B组)各25例.B组经单腔气管导管插入Coopdech支气管阻塞导管实现单肺通气,A组通过插入双腔支气管导管实现单肺通气.记录指标:①单肺通气前、单肺通气后30 min、60 min的PaO2、PaCO2、pH、呼气末二氧化碳分压(PETCO2)、气道峰压(PAW)、脉搏血氧饱和度(SpO2)；②插管和定位时间；③单肺通气时肺萎陷质量和外科暴露程度；④术后声音嘶哑和咽喉痛发生情况.结果 ①2组PaO2、PaCO2、pH、PET CO2、SpO2差异无统计学意义(P＞0.05),单肺通气后30 min、60 min的PAW A组分别为(22.1±2.0)cm H2O(1 cm H2O =0.098 kPa)、(21.7±1.8)cm H2O,明显高于B组(18.1±2.1)cm H2O、(18.2 ±2.1)cm H2O(P ＜0.05)；②A组的插管和定位时间分别为(2.8±0.7)min、(4.2±1.6) min,较B组[(1.0±0.3)min、(1.1 ±0.2)min]明显长(P＜0.05)；③单肺通气肺萎陷质量和外科术野暴露程度在2组间差异无统计学意义(P＞0.05)；④A组术后声音嘶哑和咽喉痛发生率分别为44.0％ (11/25)、48.0％(12/25),较B组[16.0％(4/25)、24.0％( 6/25)]明显升高(P＜0.05).结论 双腔支气管和Coopdech支气管阻塞导管在胸腔镜手术单肺通气的应用均安全、有效,应用支气管阻塞导管插管和定位方便快捷,可降低患者术后声音嘶哑及咽喉疼痛的发生率,在适应证范围内的胸腔镜手术中可以优先选用Coopdech支气管阻塞导管.%Objective To observe the effects of coopdech bronchial blocker tube for one-lung ventilation in video-assisted thoracic surgery.Methods Fifty patients ( ASA Ⅰ - Ⅱ ) undergoing video-assisted thoracic surgery by one-lung ventilation were randomly divided into group A and group B (n =25 ).One-lung ventilation was achieved by double-lumen tube in group A and coopdech bronchial blocker tube combined with single-lumen endotracheal tube in group B.The following variables were recorded:PaO2,PaCO2,pH,PETCO2,SpO2 and airway pressure(PAW)before one-lung ventilation and at 30,60 min after one-lung ventilation; time of intubation tube and location,lung collapse and surgical exposure of the operated field during one-lung ventilation were observed.The incidence of postoperative hoarseness and sore throat was assessed.Results There were no significant differences in PaO2,PaCO2,pH,PETCO2 and SpO2 between two groups( P ＞ 0.05 ).PAW was significantly lower after one-lung ventilation in group B than that in group A [ ( 18.1 ± 2.1 ) cm H2 O vs (22.1 ± 2.0) cm H2O at 30 min,( 18.2 ± 2.1 ) cm H2O vs21.7 ± 1.8 cm H2O at 60 min] (P＜0.05) ; the time of intubation tube and location in group A were significantly longer than those in group B[(2.8 ±0.7)min vs (1.0±0.3)min,(4.2±1.6)min vs (1.1 ±O.2)min] P＜0.05).There were no statistical differences in lung collapse and surgical exposure of the operated field during onelung ventilation between two groups.The incidence of postoperative hoarseness and sore throat was significantly higher in group A than that in group B (44.0％ vs 16.0％,48.0％ vs 24.0％ ) ( P ＜ 0.05 ).Conclusions One-lung ventilation can be achieved via either a double-lumen tube or a coopdech bronchial blocker tube,however use of coopdech bronchial blocker tube is easy and quick in intubation tube and location.It can reduce the incidence of postoperative hoarseness and sore throat,therefore it is recommended for one-lung ventilation in video-assisted thoracic surgery.