CAJ | 학술논문

目的评价Supreme喉罩联合Coopdech支气管阻塞器用于食道癌根治术患者气道管理的可行性和效果. 方法采用随机数字表法将择期全麻下行经胸食道癌根治术患者60例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,年龄65岁～78岁,随机分为3组(每组20例):双腔支气管插管组(DT组),Coopdech支气管阻塞器组(TC组)和Supreme喉罩联合Coopdech支气管阻塞器(SC组).记录一次插管成功率及插管和定位时间;观察术中导管移位、需行纤维支气管镜检查例数和评价术中肺萎陷的情况;术后24 h咽喉疼痛及声音嘶哑和术后肺不张的发生例数;观察麻醉前(T0),插管即刻(T1),插管后1(T2)、3(T3)、5 min(T4)的血流动力学和脑电双频指数(bispectral index,BIS)变化;记录双肺通气10 min (T5),单肺通气(one lung ventilation,OLV)10(T6)、30(T7)、60 min (T8)时气道压(airway pressure,Paw)和呼气末二氧化碳分压(end tidal carbon dioxide partialpressure,PETCO2). 结果与DT组比较,TC组和SC组的插管和定位时间明显短于DT组(P＜0.05),TC组和SC组间差异无统计学意义(P＞0.05);与T1时刻比较,在T2-4时刻,DT组和TC组收缩压(systolic pressure,SP)、舒张压(diastolic pressure,DP)、心率(heart rate,HR)及BIS明显升高(P＜0.05),SC组BP、DP、HR和BIS无明显变化(P＞0.05);与DT组比较,SC组和TC组T2-4时刻BP、DP、HR和BIS明显降低(P＜0.05);术中OLV(T6-8)时,DT组气道压力明显高于SC组(P＜0.05),3组间PETCO2差异无统计学意义(P＞0.05);术中导管移位、需行纤维支气管镜检查例数、肺萎陷程度差异、术后肺不张发生率3组差异无统计学意义(P＞0.05);SC组术后24 h咽喉疼痛、声音嘶哑(20％)发生率,明显低于DT组(85％)和TC组(45％)(P＜0.05或P＜0.01). 结论 Supreme喉罩联合Coopdech支气管阻塞器可安全用于食道癌根治术患者气道管理.
목적 평개Supreme후조연합Coopdech지기관조새기용우식도암근치술환자기도관리적가행성화효과. 방법 채용수궤수자표법장택기전마하행경흉식도암근치술환자60례,미국마취의사협회(ASA)분급Ⅰ～Ⅲ급,년령65세～78세,수궤분위3조(매조20례):쌍강지기관삽관조(DT조),Coopdech지기관조새기조(TC조)화Supreme후조연합Coopdech지기관조새기(SC조).기록일차삽관성공솔급삽관화정위시간;관찰술중도관이위、수행섬유지기관경검사례수화평개술중폐위함적정황;술후24 h인후동통급성음시아화술후폐불장적발생례수;관찰마취전(T0),삽관즉각(T1),삽관후1(T2)、3(T3)、5 min(T4)적혈류동역학화뇌전쌍빈지수(bispectral index,BIS)변화;기록쌍폐통기10 min (T5),단폐통기(one lung ventilation,OLV)10(T6)、30(T7)、60 min (T8)시기도압(airway pressure,Paw)화호기말이양화탄분압(end tidal carbon dioxide partialpressure,PETCO2). 결과 여DT조비교,TC조화SC조적삽관화정위시간명현단우DT조(P＜0.05),TC조화SC조간차이무통계학의의(P＞0.05);여T1시각비교,재T2-4시각,DT조화TC조수축압(systolic pressure,SP)、서장압(diastolic pressure,DP)、심솔(heart rate,HR)급BIS명현승고(P＜0.05),SC조BP、DP、HR화BIS무명현변화(P＞0.05);여DT조비교,SC조화TC조T2-4시각BP、DP、HR화BIS명현강저(P＜0.05);술중OLV(T6-8)시,DT조기도압력명현고우SC조(P＜0.05),3조간PETCO2차이무통계학의의(P＞0.05);술중도관이위、수행섬유지기관경검사례수、폐위함정도차이、술후폐불장발생솔3조차이무통계학의의(P＞0.05);SC조술후24 h인후동통、성음시아(20％)발생솔,명현저우DT조(85％)화TC조(45％)(P＜0.05혹P＜0.01). 결론 Supreme후조연합Coopdech지기관조새기가안전용우식도암근치술환자기도관리.
Objective To evaluate the efficacy of Coopdech bronchial blocker combined with a laryngeal mask airway Supreme for airway management in patients undergoing esophageal carinoma resection.Methods Sixty patients undegoing esophageal carcinoma resection were randomly divided into 3 groups (n=20):double-lumen tube group (group DT),Coopdech bronchial blocker combined with single-lumen tube group (group TC) and Coopdech bronchial blocker combined with a laryngeal mask airway Supreme group (group SC).The fiberoptic bronchoscope was used to assist endotracheal tube positioning in both groups.The first attempt success rates of intubation,the intubation time,positioning time,the number of fiberoptic bronchoscopy attempts,degree of lung collapse,postoperative atelectasis,postoperative sore throat and hoarseness were recorded.Blood pressure (BP),heart rate (HR) and bispectral index (BIS) were recorded before anesthesia(T0),immediately after intubation(T1) and at 1,3 min and 5 min after intubation (T2-4).Airway pressure (Paw) and end tidal carbon dioxide partial pressure (PETCO2) was recorded at two lung ventilation 10 min(T5) and 10 (T6),30(T7),60 min(T8) after one lung ventilation(OLV).Results Compared to group DT,The intubation time and the positioning time was significantly shorter in group TC and group SC.Compared with T1,HR,BP and BIS significantly increased in group TC and group SC group at number of patients required for tube T2-4.Compared with group group DT,there was no significant difference in SP,DP,HR,BIS,the displacement,the number of fiberoptic bronchoscopy attempts and degree of lung collapse among the three groups.Paw was significantly higher during OLV at group DT than group SC.Incidences of postoperative sore throat and hoarseness were significantly lower in group SC (20％) compared to group DT (80％) and group TC (45％).Conclusions The efficacy of the Coopdech bronchial blocker combined laryngeal mask airway Supreme is safe in patents undergoing esophageal carinoma resection.