Coopdech支气管堵塞导管行左下肺叶隔离的可行性
Coopdech지기관도새도관행좌하폐협격리적가행성
The feasibility of selective left lower lobar blockade based on Coopdech endobronchial blocker tube
  • 万方数据
    国际麻醉学与复苏杂志 국제마취학여복소잡지
    INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
    2010年 1期 37-41 ,共5页

    叶靖%张朝群%古妙宁%秦再生%蔡开灿%蔡瑞君

    협정%장조군%고묘저%진재생%채개찬%채서군

    肺叶隔离%支气管堵塞导管%单肺通气%双腔支气管导管%肺顺应性%吸气峰压 肺葉隔離%支氣管堵塞導管%單肺通氣%雙腔支氣管導管%肺順應性%吸氣峰壓
    폐협격리%지기관도새도관%단폐통기%쌍강지기관도관%폐순응성%흡기봉압
    Selective lobar blockade%Endobronchial blocker tube%Double-lumen endobronchial tube%One lung ventilation%Dynamic lung compliance%Peak inspiratory airway pressure
    目的 观察Coopdeeh支气管堵塞导管对肺功能正常的下段食管癌根治术患者作左下肺叶隔离的可行性,以及对患者肺顺应性、吸气峰压和氧合作用的影响.方法 拟行左侧剖胸下段食管癌根治术患者30例,ASAⅠ～Ⅱ级,按随机数字表法,随机分成支气管堵塞导管组(BB组)和左双腔支气管导管(double-lumen endobronchial tube,DLT)组(DLT组),每组15例.丙泊酚靶控输注静脉诱导后.BB组插入8# 单腔气管导管,纤维支气管镜引导9 Fr Coopdech支气管堵塞导管置入左下肺叶支气管,DLT组插入左DLT,2组均作双肺间歇正压通气.20 min后摆放右侧卧位,DLT组行右单肺通气,BB组对堵塞导管套囊充气行右肺和左上肺叶通气.20 min后手术开始,全程采用丙泊酚靶控输注维持麻醉,间歇追加舒芬太尼和顺阿曲库铵.于双肺通气后20 min(T_1),右单肺通气或右肺和左上肺叶通气后20 min(T_2),开胸见左肺或左下肺叶完全萎陷后(T_3),术毕拔出气管导管前(T_4)行动脉血气分析,记录肺顺应性和吸气峰压,并请手术医生在开胸后即刻评价术野清晰度.观察期间,机械通气参数不变.术后第1天作动脉血气分析和胸片检查.结果 2组患者的术野评价,各时点pH、动脉二氧化碳分压,T_1的动脉氧分压、吸气峰压和肺顺应性差异无统计学意义.在T_2～T_4时点,BB组的PaO_2分别为(220±56)mmHg、(188±57)mg Hg、(208±24)mm Hg,高于DLT组(146±38)mm Hg、(140±36)mm Hg、(157±33)mm Hg;肺顺应性分别为(36±9)ml/cm H_2O,高于DLT组(24±6)ml/cm H_2O,(35±12)ml/cm H_2O,BB组的吸气峰压分别为(17.7±2.9)cm H_2O、(17.8±3.2)cm H_2O、(14.82.2)cm H_2O,低于DLT组的(21.7±3.6)cm H_2O、(22.6±2.6)cm H_2O,(16.8±1.8)cm H_2O(P<0.05).BB组术后无肺不张病例,DLT组有1例发生左下肺不张.结论 支气管堵塞导管行左下肺叶隔离能在左侧剖胸下段食管癌根治术中提供清晰的术野,并能降低患者的吸气峰压,改善肺顺应性、增加氧合.
    목적 관찰Coopdeeh지기관도새도관대폐공능정상적하단식관암근치술환자작좌하폐협격리적가행성,이급대환자폐순응성、흡기봉압화양합작용적영향.방법 의행좌측부흉하단식관암근치술환자30례,ASAⅠ～Ⅱ급,안수궤수자표법,수궤분성지기관도새도관조(BB조)화좌쌍강지기관도관(double-lumen endobronchial tube,DLT)조(DLT조),매조15례.병박분파공수주정맥유도후.BB조삽입8# 단강기관도관,섬유지기관경인도9 Fr Coopdech지기관도새도관치입좌하폐협지기관,DLT조삽입좌DLT,2조균작쌍폐간헐정압통기.20 min후파방우측와위,DLT조행우단폐통기,BB조대도새도관투낭충기행우폐화좌상폐협통기.20 min후수술개시,전정채용병박분파공수주유지마취,간헐추가서분태니화순아곡고안.우쌍폐통기후20 min(T_1),우단폐통기혹우폐화좌상폐협통기후20 min(T_2),개흉견좌폐혹좌하폐협완전위함후(T_3),술필발출기관도관전(T_4)행동맥혈기분석,기록폐순응성화흡기봉압,병청수술의생재개흉후즉각평개술야청석도.관찰기간,궤계통기삼수불변.술후제1천작동맥혈기분석화흉편검사.결과 2조환자적술야평개,각시점pH、동맥이양화탄분압,T_1적동맥양분압、흡기봉압화폐순응성차이무통계학의의.재T_2～T_4시점,BB조적PaO_2분별위(220±56)mmHg、(188±57)mg Hg、(208±24)mm Hg,고우DLT조(146±38)mm Hg、(140±36)mm Hg、(157±33)mm Hg;폐순응성분별위(36±9)ml/cm H_2O,고우DLT조(24±6)ml/cm H_2O,(35±12)ml/cm H_2O,BB조적흡기봉압분별위(17.7±2.9)cm H_2O、(17.8±3.2)cm H_2O、(14.82.2)cm H_2O,저우DLT조적(21.7±3.6)cm H_2O、(22.6±2.6)cm H_2O,(16.8±1.8)cm H_2O(P<0.05).BB조술후무폐불장병례,DLT조유1례발생좌하폐불장.결론 지기관도새도관행좌하폐협격리능재좌측부흉하단식관암근치술중제공청석적술야,병능강저환자적흡기봉압,개선폐순응성、증가양합.
    Objective To observe the feasibility of selective left lower lobar blockade by Coopdech endobronchial blocker tube (BB)in patients with normal spirometry during left-sided lower esophageal surgery, and the effects on dynamic lung compliance (Cdyn), peak inspiratory airway pressure(Ppeak)and arterial oxygenation. Methods 30 patients(aged 44-64 yr)scheduled for left-sided lower esophageal surgery were allocated randomly to two groups: Group BB or group double-lumen endobronchial tubes (DLT)(n=15). Anesthesia was induced and maintained with Propofol by target controlled infusion, administered sufentanil and cisatracurium intravenously if needed. The left-sided DLT was placed in the DLT group and an 8.0-mm internal diameter single-lumen endotracheal tube was used in the BB group and 9 French Coopdech blocker was advanced into the left lower lobar bronchus with the guidance of a fiberoptic bronchoscope in the latter group. The variables recorded were Ppeak, Cdyn and arterial blood gas analyses data at four surgical times: 20 minutes after two-lung ventilation in supine position (T_1), 20 minutes after initiation of one-lung ventilation or selective left lower lobar blockade by inflating BB balloons in right lateral decubitus position (T_2), total collapse of left lung or left lower lobe after the pleura was opened(T_3) and before tracheal extubation(T_4). Tidal volume and respiratory rate were kept constant at each time. Once the pleura were opened, the effectiveness of lung collapse was evaluated by the surgeon who performed the surgery. Chest radiograph and arterial blood gas analyses were performed in the first postoperative day. Results The groups were comparable with regard to rank of surgical exposure; pH, PaCO_2 from T_1 to T_4; Cdyn, Ppeak, PaO_2 at T_1. Significant trends were found toward a higher decrease in Ppeak [ (17.7±2.9) cm H_2O vs (21.7±3.6) cm H_2O in T_2, (17.8±3,2) cm H_2O vs (22.6±2.6) cm H_2O in T_3,(14.8±2.2) cm H_2O vs(16.8±1.8) cm H_2O in T_4, respectively] and a better improvement in cdyn[ (36±9) ml/cm H_2O vs (24±6) ml/cm H_2O in T_2, (37±10) ml/cm H_2O vs (23±6) ml/cm H_2O in T_3, (44±8) ml/cm H_2O vs (35±12) ml/cm H_2O in T_4, respectively], PaO_2[ (220±56) mm Hg vs (146±38) mm Hg in T_2, (188±57) mm Hg vs (140±36) mm Hg in T_3, (208±24) mm Hg vs(157±33) mm Hg in T_4, respectively] during the operation with the BB compared to DLT (P<0.05 or <0.01). No lobe collapse was observed in the postoperative period in BB group, but 1 patients of DLT group was found left lower lobe atelectasis. A better postoperative arterial oxygenation was shown in BB group (P<0.01). Conclusion Selective left lower lobar blockade achieved by Coopdech endobronchial blocker tube during left-sided esophageal surgery provides a good surgical exposure, together with a lower intraoperative peak inspiratory airway pressure, and better arterial oxygenation and dynamic lung compliance.
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