CAJ | 학술논문

目的比较支气管封堵器与双腔支气管导管用于食管癌根治术病人单肺通气的效果.方法择期行食管癌根治术的病人40例,性别不限,年龄42 ～ 63岁,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将其分为2组(n=30):双腔支气管导管组(DLT组)和支气管封堵器组(BB组).麻醉诱导后,DLT组经口插入左侧双腔支气管导管,随后用纤维支气管镜调整导管的位置.BB组先经口插入单腔气管导管,随后在纤维支气管镜的引导下插入支气管封堵器.记录插管时间、单肺通气时间、肺萎陷时间、手术时间、拔管时间、导管移位和低氧血症的发生情况；术毕行肺萎陷评分；记录气管拔管后2d内声嘶、喉痛的发生情况和术后7d内肺部感染的发生情况.结果与DLT组比较,BB组插管时间和肺萎陷时间延长,术后声嘶和喉痛发生率降低(P＜0.05),单肺通气时间、手术时间、拔管时间、肺萎陷评分、导管移位、低氧血症和术后肺部感染的发生率差异无统计学意义(P＞0.05).结论支气管封堵器用于食管癌根治术病人单肺通气的效果与双腔支气管导管相似.
목적 비교지기관봉도기여쌍강지기관도관용우식관암근치술병인단폐통기적효과.방법 택기행식관암근치술적병인40례,성별불한,년령42 ～ 63세,ASA분급Ⅰ～Ⅲ급,채용수궤수자표법,장기분위2조(n=30):쌍강지기관도관조(DLT조)화지기관봉도기조(BB조).마취유도후,DLT조경구삽입좌측쌍강지기관도관,수후용섬유지기관경조정도관적위치.BB조선경구삽입단강기관도관,수후재섬유지기관경적인도하삽입지기관봉도기.기록삽관시간、단폐통기시간、폐위함시간、수술시간、발관시간、도관이위화저양혈증적발생정황；술필행폐위함평분；기록기관발관후2d내성시、후통적발생정황화술후7d내폐부감염적발생정황.결과 여DLT조비교,BB조삽관시간화폐위함시간연장,술후성시화후통발생솔강저(P＜0.05),단폐통기시간、수술시간、발관시간、폐위함평분、도관이위、저양혈증화술후폐부감염적발생솔차이무통계학의의(P＞0.05).결론 지기관봉도기용우식관암근치술병인단폐통기적효과여쌍강지기관도관상사.
Objective To compare the bronchial blocker and double-lumen tube for one-lung ventilation in patients undergoing esophageal cancer resection.Methods Forty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 42-63 yr,scheduled for elective esophageal cancer resection,were randomly divided into 2 groups (n =20 each):double-lumen endotracheal tube group (group DLT) and bronchial blocker group (group BB).After induction of anesthesia,the patients were intubated with a left-sided double-lumen endotracheal tube and correct positioning was verified by fiberoptic bronchoscopy in group DLT.After induction of anesthesia,the patients were intubated with a conventional single-lumen endotracheal tube,and then the bronchial blocker was inserted under the guidance of fiberoptic bronchoscope in group BB.The intubation time,one-lung ventilation time,time to achieve lung collapse,operation time,extubation time,tube malposition and hypoxemia were recorded.The lung collapse was scored at the end of operation.Hoarseness and throat sore within 2 days after extubation and pulmonary infections within 7 days after operation were recorded.Results Compared with group DLT,intubation time and time to achieve lung collapse were significantly prolonged,and the incidence of hoarseness and throat sore within 2 days after extubation was decreased in group BB (P ＜ 0.05).There was no significant difference in the one-lung ventilation time,operation time,extubation time,lung collapse score,incidence of tube malposition,hypoxemia and pulmonary infections within 7 days after operation between the two groups (P ＞ 0.05).Conclusion The efficacy of bronchial blocker is similar to that of double-lumen tube when used for one-lung ventilation in patients undergoing esophageal cancer resection.