CAJ | 학술논문

目的：比较双腔支气管导管与纤支镜引导下插入支气管堵塞器2种单肺通气方式的麻醉操作、血流动力学、呼吸功能监测的变化。方法胸外科手术行单肺通气患者40例，用抽签法随机分为2组，每组20例，对照组（A组）行双腔支气管导管下行单肺通气，观察组（B组）行纤支镜引导下插入支气管堵塞器行单肺通气。分别行麻醉操作监测，包括插管次数、插管时间、纤支镜定位时间、手术野暴露满意及术后咽喉疼痛及肺部感染；在 T0（术前30 min）、T1（单肺通气30 min）、T2（单肺通气60 min）、T3（术后6 h）时间点进行血流动力学监测和呼吸功能监测，并记录 HR、MAP、CVP、CO、SVV数据和 SPO2、PetCO2、Paw、CLdyn、PO2、PCO2数据。结果1）插管时间、纤支镜定位时间，B组明显优于 A组（P＜0．05）；术野暴露满意度和术后肺部感染发生率，A组与 B组比较差异无统计学意义（P＞0．05）；术后声嘶咽喉疼痛发生率，A组明显高于B组（P＜0．05）。2）T1、T2时，A组较B组 HR变化明显，A组或B组 MAP、CVP、CO、SV、SVV明显优于T0。3）T1、T2时，Paw、CLdyn B组明显优于 A组。T1、T2时， A组或B组PetCO2、Paw、CLdyn、PO2、PCO2明显优于T0。结论在胸外科手术中使用纤支镜定位简单准确、手术视野清晰、术后并发症少，使用支气管堵塞器在肺顺应性、气道阻力及对心脏负荷的影响方面都明显优于双腔支气管导管。
목적：비교쌍강지기관도관여섬지경인도하삽입지기관도새기2충단폐통기방식적마취조작、혈류동역학、호흡공능감측적변화。방법흉외과수술행단폐통기환자40례，용추첨법수궤분위2조，매조20례，대조조（A조）행쌍강지기관도관하행단폐통기，관찰조（B조）행섬지경인도하삽입지기관도새기행단폐통기。분별행마취조작감측，포괄삽관차수、삽관시간、섬지경정위시간、수술야폭로만의급술후인후동통급폐부감염；재 T0（술전30 min）、T1（단폐통기30 min）、T2（단폐통기60 min）、T3（술후6 h）시간점진행혈류동역학감측화호흡공능감측，병기록 HR、MAP、CVP、CO、SVV수거화 SPO2、PetCO2、Paw、CLdyn、PO2、PCO2수거。결과1）삽관시간、섬지경정위시간，B조명현우우 A조（P＜0．05）；술야폭로만의도화술후폐부감염발생솔，A조여 B조비교차이무통계학의의（P＞0．05）；술후성시인후동통발생솔，A조명현고우B조（P＜0．05）。2）T1、T2시，A조교B조 HR변화명현，A조혹B조 MAP、CVP、CO、SV、SVV명현우우T0。3）T1、T2시，Paw、CLdyn B조명현우우 A조。T1、T2시， A조혹B조PetCO2、Paw、CLdyn、PO2、PCO2명현우우T0。결론재흉외과수술중사용섬지경정위간단준학、수술시야청석、술후병발증소，사용지기관도새기재폐순응성、기도조력급대심장부하적영향방면도명현우우쌍강지기관도관。
Objective To compare the anesthesia operability,hemodynamics and respiratory function in single lung ventilation using double-lumen endobronchial tube displacement and fibro-bronchoscopy-guided bronchial blocker insertion.Methods Forty patients undergoing thoracic surgery were randomly assigned to receive either double-lumen endobronchial tube displacement (group A,n=20)or fibrobronchoscopy-guided bronchial blocker insertion (group B,n=20)for single lung ventilation.The number of intubation attempts,intubation time,bronchoscopic posi-tioning time,operation field exposure satisfaction,postoperative sore throat and pulmonary infec-tion were observed in both groups.Hemodynamic and respiratory monitoring was performed and heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),cardiac output (CO),stroke volume variation (SVV),arterial oxygen saturation (SPO2 ),end-tidal carbon diox-ide tension (PetCO2 ),airway pressure (Paw),dynamic pulmonary compliance (CLdyn),PO2 and PCO2 were recorded 30 minutes before operation (T0 ),single lung ventilation for 30 minutes (T1 ),single lung ventilation for 60 minutes (T2 )and 6 hours after operation (T3 ).Results Com-pared with group A,intubation time and bronchoscopic positioning time were significantly short-ened and incidences of voice hoarse and sore throat were significantly reduced in group B (P<0.05).There were no significant differences in operation field exposure satisfaction and incidence of postoperative pulmonary infection between the two groups (P>0.05).Compared with group B,HR was obviously changed in group A (P<0.05).Compared with T0,the MAP,CVP,CO,SV,SVV,PetCO2 ,Paw,CLdyn,PO2 and PCO2 were obviously improved in both groups at T1 and T2 (P<0.05).Compared with group A,the Paw and CLdyn were obviously improved in group B (P<0.05).Conclusion In thoracic surgery,fibrobronchoscopy leads to simple and accurate posi-tioning,clear surgical field and less postoperative complications.Bronchial blocker is superior to double-lumen endobronchial tube for improving lung compliance,airway resistance and cardiac load.