不同体位联合气管导管斜面盲探置入支气管堵塞器在单肺通气中的临床研究

摘要

目的 探讨不同体位下联合气管导管开口斜面引导对盲探置入支气管堵塞器的影响.方法 选择本院开胸手术的患者,设置小儿和成人两大组,每组30例.每一大组均随机分为三组比较研究:A组患者在仰卧位完成插管且导管斜面随机,然后盲探置入支气管堵塞器;B组患者在仰卧位插管且气管导管斜面朝向封堵侧后置入支气管堵塞器(A组和B组均在仰卧位堵塞器后摆侧卧位);C组患者在仰卧位插管且气管导管斜面朝向封堵侧,摆体位后,再置入支气管堵塞器.记录三组患者堵塞器一次到位成功率、封堵总耗时、置入期间低氧血症发生率、术后气道水肿发生率.结果 小儿组中C组患儿的堵塞器一次到位成功率明显高于A组与B组(P＜0.05);成人组中B组、C组患者的堵塞器一次到位成功率明显高于A组(P＜0.05);封堵总耗时在成人及小儿中B组、C组中明显均少于A组(均P＜ 0.05);气道水肿及低氧血症发生率在成人及小儿中A组与B组比较差异无统计学意义(P＞ 0.05),C组发生率明显低于A组(P＜0.05).结论 通过调整体位和利用气管导管开口斜面引导能有效提高置入的成功率,减少插管并发症,值得临床推广.%Objective To investigate the effect of different position combined with guidance of tracheal catheter oblique plane opening on the blind insertion of bronchial blocker.Methods 30 children and 30 adults scheduled for thoracotomy were chosen from our hospital,both the children group and adult group were randomly subdivided into three groups.The patients in Group A were intubated in the supine position on the random catheter oblique plane,and then were inserted the bronchial blocker blindly;the patients in Group B were intubated in the supine position on the catheter oblique plane toward the sealing side,and then were inserted the bronchial blocker (both Group A and Group B were placed in the lateral position after the insertion of bronchial blocker);the patients in Group C were intubated in the supine position on the catheter oblique plane toward the sealing side,were placed in the lateral position,and then were inserted the bronchial blocker.The one-time success rate of bronchial blocker insertion,the total time of occlusion,the incidence of hypoxemia during the insertion,the incidence of postoperative airway edema in the three groups were recorded.Results In the children group,the one-time success rate of bronchial blocker insertion in Group C was significantly higher than those in Group A and Group B (P＜0.05);in the adult group,the one-time success rate of bronchial blocker insertion in Group B and Group C were significantly higher than that in Group A (P＜0.05).The total time of occlusion in Group B and Group C were shorter than that in Group A in both the children group and adult group (P＜0.05).In both the children group and adult group,the incidences of airway edema and hypoxemia in Group C were significantly lower than those in Group A (P＜0.05),but without statistically significant differences between Group B and Group A (P＞0.05).Conclusion By adjusting the position and using guidance of tracheal catheter oblique plane opening,the success rate and the rate of insertion can be effectively improved,and the complications of intubation can be reduced,which is worthy of clinical popularization.