中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
11期
1361-1364
,共4页
插管法,气管内%呼吸,人工%冠状动脉分流术%老年人
插管法,氣管內%呼吸,人工%冠狀動脈分流術%老年人
삽관법,기관내%호흡,인공%관상동맥분류술%노년인
Intubation,intratracheal%Respiration,artificial%Coronary artery bypass%Aged
目的 比较支气管封堵器与双腔支气管导管用于小切口冠状动脉旁路移植术老年患者单肺通气的效果.方法 择期行左胸部小切口冠状动脉旁路移植术患者36例,性别不限,年龄65～78岁,左室射血分数≥45％,BMI＜ 30 kg/m2,ASA分级Ⅱ或Ⅲ级,心功能分级Ⅰ-Ⅲ级,采用随机数字表法,将其分为2组(n=18):双腔气管导管组(D组)和支气管封堵器组(B组).依次静脉注射咪达唑仑0.05 mg/kg、依托咪酯0.3 mg/kg、芬太尼10 μg/kg和顺阿曲库铵0.15 ～ 0.20 mg/kg行麻醉诱导,5 min后经口明视气管插管,D组插入左侧双腔支气管导管,B组先插入单腔支气管导管,随后插入Coopdech支气管封堵器,行机械通气.于麻醉诱导前、气管插管前2 min、气管插管前即刻、气管插管后即刻、气管插管后1 min和气管插管后2 min时记录MAP、HR和平均肺动脉压,并计算心率收缩压乘积(RPP),记录麻醉诱导过程中血管活性药的使用情况.记录打开胸膜后肺自然萎陷情况,术毕行术野暴露评分.结果 与D组比较,B组气管插管后MAP和HR降低,气管插管后心率收缩压乘积和平均肺动脉压降低,尼卡地平及艾司洛尔的使用率降低(P＜0.05),阿托品及间羟胺的使用率差异无统计学意义,肺自然萎陷率和术野暴露评分差异无统计学意义(P＞0.05).结论 与双腔支气管导管比较,支气管封堵器用于小切口冠状动脉旁路移植术老年患者单肺通气时,不但可提供满意的手术操作空间,而且气管插管诱发血流动力学波动小.
目的 比較支氣管封堵器與雙腔支氣管導管用于小切口冠狀動脈徬路移植術老年患者單肺通氣的效果.方法 擇期行左胸部小切口冠狀動脈徬路移植術患者36例,性彆不限,年齡65～78歲,左室射血分數≥45％,BMI＜ 30 kg/m2,ASA分級Ⅱ或Ⅲ級,心功能分級Ⅰ-Ⅲ級,採用隨機數字錶法,將其分為2組(n=18):雙腔氣管導管組(D組)和支氣管封堵器組(B組).依次靜脈註射咪達唑崙0.05 mg/kg、依託咪酯0.3 mg/kg、芬太尼10 μg/kg和順阿麯庫銨0.15 ～ 0.20 mg/kg行痳醉誘導,5 min後經口明視氣管插管,D組插入左側雙腔支氣管導管,B組先插入單腔支氣管導管,隨後插入Coopdech支氣管封堵器,行機械通氣.于痳醉誘導前、氣管插管前2 min、氣管插管前即刻、氣管插管後即刻、氣管插管後1 min和氣管插管後2 min時記錄MAP、HR和平均肺動脈壓,併計算心率收縮壓乘積(RPP),記錄痳醉誘導過程中血管活性藥的使用情況.記錄打開胸膜後肺自然萎陷情況,術畢行術野暴露評分.結果 與D組比較,B組氣管插管後MAP和HR降低,氣管插管後心率收縮壓乘積和平均肺動脈壓降低,尼卡地平及艾司洛爾的使用率降低(P＜0.05),阿託品及間羥胺的使用率差異無統計學意義,肺自然萎陷率和術野暴露評分差異無統計學意義(P＞0.05).結論 與雙腔支氣管導管比較,支氣管封堵器用于小切口冠狀動脈徬路移植術老年患者單肺通氣時,不但可提供滿意的手術操作空間,而且氣管插管誘髮血流動力學波動小.
목적 비교지기관봉도기여쌍강지기관도관용우소절구관상동맥방로이식술노년환자단폐통기적효과.방법 택기행좌흉부소절구관상동맥방로이식술환자36례,성별불한,년령65～78세,좌실사혈분수≥45％,BMI＜ 30 kg/m2,ASA분급Ⅱ혹Ⅲ급,심공능분급Ⅰ-Ⅲ급,채용수궤수자표법,장기분위2조(n=18):쌍강기관도관조(D조)화지기관봉도기조(B조).의차정맥주사미체서륜0.05 mg/kg、의탁미지0.3 mg/kg、분태니10 μg/kg화순아곡고안0.15 ～ 0.20 mg/kg행마취유도,5 min후경구명시기관삽관,D조삽입좌측쌍강지기관도관,B조선삽입단강지기관도관,수후삽입Coopdech지기관봉도기,행궤계통기.우마취유도전、기관삽관전2 min、기관삽관전즉각、기관삽관후즉각、기관삽관후1 min화기관삽관후2 min시기록MAP、HR화평균폐동맥압,병계산심솔수축압승적(RPP),기록마취유도과정중혈관활성약적사용정황.기록타개흉막후폐자연위함정황,술필행술야폭로평분.결과 여D조비교,B조기관삽관후MAP화HR강저,기관삽관후심솔수축압승적화평균폐동맥압강저,니잡지평급애사락이적사용솔강저(P＜0.05),아탁품급간간알적사용솔차이무통계학의의,폐자연위함솔화술야폭로평분차이무통계학의의(P＞0.05).결론 여쌍강지기관도관비교,지기관봉도기용우소절구관상동맥방로이식술노년환자단폐통기시,불단가제공만의적수술조작공간,이차기관삽관유발혈류동역학파동소.
Objective To compare the bronchial blocker and double-lumen tube for one-lung ventilation in the elderly patients undergoing minimally invasive direct coronary artery bypass (MIDCAB).Methods Thirty six patients of both sexes,aged 65-78 yr,with the left ventricular ejection fraction ≥ 45％,with body mass index ＜ 30 kg/m2,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅰ-Ⅲ),scheduled for elective MIDCAB in the left thorax,were randomly divided into 2 groups (n =18 each):double-lumen endotracheal tube group (group D) and bronchial blocker group (group B).Anesthesia was induced with midazolam 0.05 mg/kg,etomidate 0.3 mg/kg,fentanyl 10μg/kg and cisatracurium 0.15-0.20 mg/kg.The patients were intubated with a left-sided double-lumen endotracheal tube 5 min later in group D.The patients were intubated with a single-lumen endotracheal tube 5 min later,and then Coopdech bronchial blocker was inserted into the primary bronchus in group B.The patients were mechanically ventilated.Before induction of anesthesia,at 2 min before intubation,immediately before and after intubation,and at 1 and 2 min after intubation,mean arterial pressure (MAP),heart rate (HR),and mean pulmonary arterial pressure (mPAP) were recorded and rate-pressure product (RPP) was calculated.The requirement for vasoactive drugs was recorded during induction of anesthesia.Lung collapse developed after the pleura was opened was also recorded.Surgical exposure was scored at the end of operation.Results Compared with group D,MAP,HR RPP and mPAP were significantly decreased after intubation,the requirement for nicardipine and esmolol was decreased,and no significant change was found in the requirement for atropine and metaraminol,rate of lung collapse and score of surgical exposure in group B.Conclusion Compared with doublelumen tube,bronchial blocker can provide sufficient exposure of the surgical filed,and intubation-induced fluctuation of hemodynamics is small in the elderly patients undergoing MIDCAB.
