新型双腔支气管导管与支气管封堵管在肺隔离手术中的应用效果比较

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摘要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。

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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

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.

Key words： silicone double-lumen tube bronchial blocker tube fiberoptic bronchoscopy one lung isolation

收稿日期: 2022-01-11

ZTFLH:

R614.2

基金资助:秦皇岛市科技支撑计划项目(201902A169)

通讯作者: 万琼,E-mail:121980729wanq@163.com

作者简介: 于洋,硕士,副主任医师。

引用本文:

于洋, 万琼, 谢艳玲, 梁淑娟. 新型双腔支气管导管与支气管封堵管在肺隔离手术中的应用效果比较[J]. 武警医学, 2022, 33(5): 373-377. YU Yang, WAN Qiong, XIE Yanling, LIANG Shujuan. Comparision of application effect of a new type of double-lumen endobronchial tube and a single-lumen tube with bronchial blocker in lung isolation surgery. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(5): 373-377.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2022/V33/I5/373

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