CAJ | 학술논문

目的：比较支气管阻塞管和双腔管在单肺通气手术中应用的临床效果和对炎性细胞因子的影响。方法：选择胸腔镜手术患者60例，随机分为 R 组（双腔管组）和 C 组（支气管阻塞管组）。然后根据阻隔肺不同，将 R 组分为 R1组（左侧双腔管），R2组（右侧双腔管），又将 C 组分为 C1组（左侧支气管），C2组（右侧支气管），每组15例。记录插管定位时间、导管移位例数、肺萎陷的质量；记录单肺通气前和单肺通气后气道峰压；单肺通气前、单肺通气45 min 测定血气分析；观察术后2天咽喉疼痛、声音嘶哑发生的情况；在麻醉诱导前、单肺通气45 min 测定肿瘤坏死因子- a、白细胞介素-6。结果：插管定位时间 R2组比C1、C2、R1三组患者的时间长（P <0.05），C1、C2、R1三组患者比较，差异无统计学意义（P >0.05）；R2组导管移位7例，比 C1、C2、R1三组患者移位的多（P <0.05），C1、C2、R1三组患者比较，差异无统计学意义（P >0.05）；R2组肺萎陷质量有5例为优，9例为良，与 C1、C2、R1三组比较，差异有统计学意义（P <0.05）；OLV 后 C 组气道峰压比 OLV 前无明显升高（P >0.05），R 组气道峰压显著升高（P <0.05）；C 组术后咽痛声嘶发生率明显低于 R 组（P <0.05）；OLV 45 min 时四组患者的 TNF - a、IL -6与麻醉诱导前比较均有明显升高（P <0.05），OLV 45 min 时四组患者的 TNF - a、IL -6相比：R1、R2组比 C1、C2组明显升高（ P <0.05）。结论：支气管阻塞管比双腔管气道阻力低，肺萎陷好，术后咽痛声嘶等并发生症发生率低。并且支气管阻塞管定位准确、快捷、方便，尤其比右侧双腔管优势明显。支气管阻塞管对炎性因子影响小，可能与插管、定位顺利，导管移位较少有关。但影响炎性因子的因素较多，有待进一步研究。
목적：비교지기관조새관화쌍강관재단폐통기수술중응용적림상효과화대염성세포인자적영향。방법：선택흉강경수술환자60례，수궤분위 R 조（쌍강관조）화 C 조（지기관조새관조）。연후근거조격폐불동，장 R 조분위 R1조（좌측쌍강관），R2조（우측쌍강관），우장 C 조분위 C1조（좌측지기관），C2조（우측지기관），매조15례。기록삽관정위시간、도관이위례수、폐위함적질량；기록단폐통기전화단폐통기후기도봉압；단폐통기전、단폐통기45 min 측정혈기분석；관찰술후2천인후동통、성음시아발생적정황；재마취유도전、단폐통기45 min 측정종류배사인자- a、백세포개소-6。결과：삽관정위시간 R2조비C1、C2、R1삼조환자적시간장（P <0.05），C1、C2、R1삼조환자비교，차이무통계학의의（P >0.05）；R2조도관이위7례，비 C1、C2、R1삼조환자이위적다（P <0.05），C1、C2、R1삼조환자비교，차이무통계학의의（P >0.05）；R2조폐위함질량유5례위우，9례위량，여 C1、C2、R1삼조비교，차이유통계학의의（P <0.05）；OLV 후 C 조기도봉압비 OLV 전무명현승고（P >0.05），R 조기도봉압현저승고（P <0.05）；C 조술후인통성시발생솔명현저우 R 조（P <0.05）；OLV 45 min 시사조환자적 TNF - a、IL -6여마취유도전비교균유명현승고（P <0.05），OLV 45 min 시사조환자적 TNF - a、IL -6상비：R1、R2조비 C1、C2조명현승고（ P <0.05）。결론：지기관조새관비쌍강관기도조력저，폐위함호，술후인통성시등병발생증발생솔저。병차지기관조새관정위준학、쾌첩、방편，우기비우측쌍강관우세명현。지기관조새관대염성인자영향소，가능여삽관、정위순리，도관이위교소유관。단영향염성인자적인소교다，유대진일보연구。
Objective To compare the performance between bronchial blocker and double - lumen tube in patients during one - lung ventilation and their effects on inflammatory factors. Method 60 patients undergoing video - assisted thoracic surgery were randomly divid-ed into group R(double - lumen tube,DLT)and group C(bronchial blocker,BB). And group R were divided into R1(group left - sided DLT)and R2(group right - sided DLT)according to different lung separation,group C were divided into C1(group left BB)and C2 (group right BB)also according to different lung isolation techniques,each group had 15 cases. The data was recorded:intubation location time,the number of tube disposition,the quality of lung collapse. Recorded the hemodynamic changes at the following time:before intuba-tion,after intubation location immediately,2 min after intubation location. Recorded peak airway pressure before and after one - lung ventila-tion. Arterial blood were drew to measure blood gas analysis,records PaCO2 and PaO2 before one - lung ventilation and OLV 45 min. The number of postoperative hoarseness and sore throat was assessed after 2 days. Arterial blood was took to measure tumor necrosis factor - a (TNF - a)interleukin - 6(IL - 6)before venous induced anesthesia and OLV 45 min. Results Intubation location time was significantly longer in group R2 than that in group C1 、group C2 and group R1(P < 0. 05),C1、C2、R1 groups were no difference(P > 0. 05). 7 patients who were found tube disposition in group R2 were more than C1、C2、R1 three groups,but there were no difference in C1、C2、R1 three groups(P > 0. 05). 5 patients who were excellent and 9 patients who were better in group R2 on the quality of lung collapse were difference than C1、C2、R1 three groups(P < 0. 05),only 1 patients who was bad was no statistically significant than C1、C2、R1 three groups(P >0. 05). Peak airway pressure before OLV was no difference in group C1 and group C2(P > 0. 05),higher than that in group R1 and group R2(P < 0. 05). And peak airway pressure in group R1 and group R2 was higher than group C1 and group C2 after OLV(P < 0. 05). MAP and HR in group R1 and group R2 before intubation location were increased than that after intubation location immediately,2 min after intu-bation location(P < 0. 05),which were no difference in group C1 and groupC2(P > 0. 05). MAP and HR in group R1、R2 were higher than that in group C1、C2 at the same intubation point(P < 0. 05). PaO2 in four groups before OLV was lower than that at OLV 45 min(P <0. 05). No significant changes were found among four groups at OLV 45 min(P > 0. 05). PaCO2 in four groups before OLV was no differ-ence than that at OLV 45 min(P > 0. 05). The number of postoperative hoarseness and sore throat were no difference after 2 days between group C1 and group C2(P > 0. 05),between group R1 and group R2(P > 0. 05),which in group C1 、C2 were significantly lower than that in group R1、R2 after postoperative 2 days(P < 0. 05). TNF - a and IL - 6 at OLV 45 min were significantly higher in group R1 than that before venous induced anesthesia in four groups(P < 0. 05). While TNF - a and IL - 6 were higher in group R1、R2 than that in group C1、C2 at OLV 45 min(P < 0. 05). Conclusion Bronchial blocker used in one - lung ventilation can take little effect on hemodynamics,pro-vide lower airway resistance and exact lung collapse,reduce the incidence of postoperative hoarseness and sore throat than double - lumen tube. Also bronchial blocker may accurately,fast and conveniently locate,especially the right double - lumen tube. And bronchial blocker has a smaller influence on inflammation factors. Maybe it could be successfully intubate and locate,be less tube displacement. However,the inflammatory factors caused by many reasons,we should makes further study.