CAJ | 학술논문

目的评价帝视内窥镜引导左侧双腔支气管导管插管的价值.方法择期胸科手术患者50例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄47 ～ 69岁,患者无困难气道因素,应用左侧Mallinekrodt双腔支气管导管插管.采用随机数字表法,将其分为2组(n=25):帝视内窥镜组(D组)和Macintosh直接喉镜组(M组).于麻醉前(基础值,T1)、麻醉诱导后气管插管前(T2)、气管插管成功即刻(T3)及气管插管后1 min(T4)、3 min(T5)时记录SBP、MAP、HR,计算HR与SBP乘积(RPP);并于上述时点采集动脉血样,采用ELISA法检测血浆肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DOPA)浓度.记录首次双腔支气管导管插管成功率及总成功率、气管插管时间、术后24 h内患者咽喉肿痛情况.结果与M组比较,D组气管插管时间缩短,首次双腔支气管导管插管成功率升高,咽痛发生率降低,T3-5时MAP、HR、RPP、E、NE、DOPA水平降低(P＜0.05).与T1时比较,M组L-5时MAP、HR、RPP、E、NE、DOPA水平升高(P＜0.05),而D组比较差异无统计学意义(P＞0.05).结论帝视内窥镜引导左侧双腔支气管导管插管有显著的临床价值.
목적 평개제시내규경인도좌측쌍강지기관도관삽관적개치.방법 택기흉과수술환자50례,ASA분급Ⅰ혹Ⅱ급,성별불한,년령47 ～ 69세,환자무곤난기도인소,응용좌측Mallinekrodt쌍강지기관도관삽관.채용수궤수자표법,장기분위2조(n=25):제시내규경조(D조)화Macintosh직접후경조(M조).우마취전(기출치,T1)、마취유도후기관삽관전(T2)、기관삽관성공즉각(T3)급기관삽관후1 min(T4)、3 min(T5)시기록SBP、MAP、HR,계산HR여SBP승적(RPP);병우상술시점채집동맥혈양,채용ELISA법검측혈장신상선소(E)、거갑신상선소(NE)、다파알(DOPA)농도.기록수차쌍강지기관도관삽관성공솔급총성공솔、기관삽관시간、술후24 h내환자인후종통정황.결과 여M조비교,D조기관삽관시간축단,수차쌍강지기관도관삽관성공솔승고,인통발생솔강저,T3-5시MAP、HR、RPP、E、NE、DOPA수평강저(P＜0.05).여T1시비교,M조L-5시MAP、HR、RPP、E、NE、DOPA수평승고(P＜0.05),이D조비교차이무통계학의의(P＞0.05).결론 제시내규경인도좌측쌍강지기관도관삽관유현저적림상개치.
Objective To evaluate the value of Disposcope-guided the left-sided double-lumen tube (DLT) intubation.Methods Fifty ASA physical status Ⅰ or Ⅱ patients,aged 47-69 yr,without difficult airway,scheduled for elective thoracic surgery,were randomly divided into 2 groups (n =25 each) using a random number table:Disposcope (group D) and Macintosh direct laryngoscope (group M).Anesthesia was induced with iv injection of midazolam,propofol,sufentanil and rocuronium.Before induction (baseline,T1),before intubation (T2),immediately after successful intubation (T3),and at 1 and 3 min after intubation (T4-5),systolic blood pressure (SBP),mean airway pressure (MAP) and heart rate (HR) were recorded,and rate-pressure (SBP) product (RPP) was calculated.Arterial blood samples were obtained at T1-5 for measurement of plasma epinephrine (E),norepinephrine (NE),and dopamine (DOPA) concentrations.The success rate of DLT intubation at first attempt,total success rate of DLT intubation,intubation time,and development of sore throat within 24 h after surgery were recorded.Results Compared with group M,the intubation time was significantly shortened,the success rate of DLT intubation at first attempt was increased,the incidence of sore throat was decreased,and the levels of MAP,HR,RPP,E,NE and DOPA were decreased at T3-5 in D group (P ＜ 0.05).Compared with the baseline value at T1,the levels of MAP,HR,RPP,E,NE and DOPA were decreased at T3-5 in M group (P ＜ 0.05),and no significant change was found in D group (P ＞ 0.05).Conclusion Disposcope-guided left-sided DLT intubation provides significant clinical value.