Arndt支气管内阻断器和双腔支气管导管在小儿单肺通气中的比较

摘要

Objective To compare the effect of Arndt endobronchial blocker and double-lumen tube on one lung ventilation in children undergoing thoracic surgery.Methods Fourty children undergoing thoracic surgery were divided into Arndt endobronchial blocker group (Group A,n =20) and double-lumen tube group (Group D,n =20) randomly.Anesthetic management and lung isolation were performed according to a standardized protocol.The changes of MAP,HR,PetCO2 and Paw were recorded at the following time point,intubation tube before (T1),intubation tube (T2),double lung ventilation (T3),one lung ventilation (T4).The intubation time,lung collapse time,one lung ventilation time,hypoxemia duration of surgery and adverse event and others were recorded.Results Arndt endobronchial blocker group compare with double-lumen tube group,the Paw and PetCO2 were lower at the time of one lung ventilation (P ＜ 0.05);the intubation time was shorter (P ＜ 0.05);the time of lung collapse was longer (P ＜ 0.05);and the lung collapse score was higher (P ＜ 0.05).Conclusion Compared with inserting double-lumen tube blind,Arndt endobronchial blocker inserted by fiber bronchoscope can provide better one lung ventilation in children undergoing thoracic surgery.%目的 比较Arndt支气管内阻断器和双腔支气管导管在小儿胸科手术中的单肺通气效果.方法 将40例择期行胸科手术的患儿采用数字表法随机分为Arndt支气管内阻断器组(A组)和双腔支气管导管组(D组),每组20例.两组患儿在麻醉诱导后行Amdt支气管内阻断器或双腔支气管导管置入.观察记录两组患儿插管前(T1)、插管时(T2)、双肺通气时(T3)、单肺通气时(T4)平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure,PetC02)及气道压力(airwaypressure,Paw)变化.记录插管时间、肺萎陷时间、单肺通气时间、术中低氧情况以及不良事件发生情况.结果 Arndt支气管内阻断器组(A组)与双腔支气管导管组(D)比较,气道压力在单肺通气时(T4),A组明显低于D组,呼气末二氧化碳分压在单肺通气时(T4),A组明显低于D组(P＜0.05);A组患儿的插管定位时间短于D组(P＜0.05),肺完全萎陷时间、萎陷程度明显长于、优于D组(P＜0.05).结论 与盲插双腔支气管导管相比,纤支镜定位Arndt支气管内阻断器在小儿胸科手术中能提供更好的单肺通气效果.