摘要/Abstract

摘要： 目的 ·对比分析气管导管外放置封堵支气管插管与单腔气管导管在婴幼儿单肺通气中的临床效果。方法 ·选择 2017年 7月— 2018年 6月于上海交通大学附属儿童医院择期行胸腔镜手术的患儿 40例。采用随机数字表格法将患儿分为封堵支气管插管组（ A组， N20）和气管导管组（ B组，N20）。2组患儿分别通过封堵支气管插管和气管导管实现单肺通气。所有操作均由同一位有经验的麻醉医师完成。记录 2组患儿的临床发生情况（包括放置和定位时间、1次单肺插管成功例数、术中移位发生例数、术后声嘶发生例数、插管前后即刻血流动力学指标）及通气指标 [包括单肺通气 5 min后的潮气量（ tidal volume，VT）、气道峰压（ peak airway pressure, Ppeak）及术侧肺萎陷程度 ]。结果 ·与 B组相比， A组患儿放置和定位时间更短（ P0.022），1次单肺插管成功例数较多（ P0.024），术中移位发生例数较少（ P0.042）及单肺通气 5 min后术侧肺萎陷程度较好（ P0.030）；但 2组患儿在插管前后即刻血流动力学指标、单肺通气 5 min后的 VT和 Ppeak、术后声嘶发生例数间差异均无统计学意义。结论 ·与单腔气管导管相比，婴幼儿行气管导管外放置封堵支气管插管的操作时间较短、成功率较高且并发症较少，可实现更有效的单肺通气，具有更好的临床应用价值。
关键词: 封堵支气管插管, 气管导管, 婴幼儿, 单肺通气
Abstract:
Objective · To analyze the clinical application of bronchial blocker and tracheal catheter in infants with one-lung ventilation. Methods · Forty patients in Children′s Hospital, Shanghai Jiao Tong University Jul. 2017 to Jun. 2018 undergoing elective thoracoscopic surgery were randomized into two groupsrandom number method, i.e. group A (bronchial blocker）and group B (tracheal catheter), with twenty cases in each group. In the two groups, one-lung ventilation was achievedblocking bronchial blocker and tracheal catheter, respectively. All operations were performedone skilled anesthesiologist. The clinical occurrences of the two groups were recorded, including placement and positioning time, immediate hemodynamic indexes before and after intubation, the number of successful cases of one-lung ventilation, the number of intraoperative shifts cases and postoperative hoarseness cases. Also, the ventilation indexes of the two groups was recorded, including tidal volume (VT), peak airway pressure (Ppeak) and intraoperative lung collapse after five minutes of one-lung ventilation. Results · Compared with group B, placement and positioning time in group A was shorter (P0.022), the number of successful rates of one-lung ventilation in group A was bigger (P0.024), the number of intraoperative shifts cases in group A was less (P0.042), and intraoperative lung collapse after five minutes of one-lung ventilation in group A was better (P0.030). There were no significant differences in immediate hemodynamic indexes before and after intubation, VT and Ppeak after five minutes of one-lung ventilation, and the number of postoperative hoarseness cases. Conclusion · Extraluminal placement of bronchial blocker used in infants has an advantages in terms of the intubation time, the success rate, and the less complications compared with the tracheal tube, which can achieve more effective one-lung ventilation and better clinical application value.
Key words: bronchial blocker, tracheal catheter, infant, one-lung ventilation


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