山东医药
山東醫藥
산동의약
SHANDONG MEDICAL JOURNAL
2014年
9期
31-33
,共3页
食管肿瘤%单肺通气%新型左主支气管阻塞器%气道峰压
食管腫瘤%單肺通氣%新型左主支氣管阻塞器%氣道峰壓
식관종류%단폐통기%신형좌주지기관조새기%기도봉압
esophageal neoplasms%one-lung ventilation%new type left bronchial blocker%peak airway pressure
目的：探讨新型左主支气管阻塞器（ NTLBB）在食管癌术中单肺通气的应用价值。方法选择ASAⅠ～Ⅱ级限期手术治疗的食管癌患者30例，在麻醉诱导后，置入NTLBB实现右侧肺通气、左侧肺萎陷，便于手术操作及减轻肺损伤。通过观察导管置入定位一次成功率、单肺通气期间气道峰压（ PEAK）和通气量（ VT）、呼吸频率（ R）、呼气末二氧化碳分压（ ETCO2）、经皮血氧饱和度（ SpO2）的变化、气道损伤程度、术后咽痛和声音嘶哑发生率，分析其在手术操作及减轻肺损伤中的作用。结果导管置入定位一次成功率为96．7％，侧卧位后经纤维支气管镜检查发现有6例（20％）支气管套囊位置需调整；与双肺通气相比，单肺通气期间PEAK稍升高，VT、R、ETCO2、SpO2变化不明显（ P均＞0．05）；气道损伤程度评分为1．42分；术后咽痛发生率40％，声音嘶哑（伴随咽痛）发生率10％。结论NTLBB用于单肺通气，具有置入定位简单、阻隔效果确切、气道损伤小、术后并发症低等优点，有助于提高食管癌患者的手术及麻醉质量。
目的：探討新型左主支氣管阻塞器（ NTLBB）在食管癌術中單肺通氣的應用價值。方法選擇ASAⅠ～Ⅱ級限期手術治療的食管癌患者30例，在痳醉誘導後，置入NTLBB實現右側肺通氣、左側肺萎陷，便于手術操作及減輕肺損傷。通過觀察導管置入定位一次成功率、單肺通氣期間氣道峰壓（ PEAK）和通氣量（ VT）、呼吸頻率（ R）、呼氣末二氧化碳分壓（ ETCO2）、經皮血氧飽和度（ SpO2）的變化、氣道損傷程度、術後嚥痛和聲音嘶啞髮生率，分析其在手術操作及減輕肺損傷中的作用。結果導管置入定位一次成功率為96．7％，側臥位後經纖維支氣管鏡檢查髮現有6例（20％）支氣管套囊位置需調整；與雙肺通氣相比，單肺通氣期間PEAK稍升高，VT、R、ETCO2、SpO2變化不明顯（ P均＞0．05）；氣道損傷程度評分為1．42分；術後嚥痛髮生率40％，聲音嘶啞（伴隨嚥痛）髮生率10％。結論NTLBB用于單肺通氣，具有置入定位簡單、阻隔效果確切、氣道損傷小、術後併髮癥低等優點，有助于提高食管癌患者的手術及痳醉質量。
목적：탐토신형좌주지기관조새기（ NTLBB）재식관암술중단폐통기적응용개치。방법선택ASAⅠ～Ⅱ급한기수술치료적식관암환자30례，재마취유도후，치입NTLBB실현우측폐통기、좌측폐위함，편우수술조작급감경폐손상。통과관찰도관치입정위일차성공솔、단폐통기기간기도봉압（ PEAK）화통기량（ VT）、호흡빈솔（ R）、호기말이양화탄분압（ ETCO2）、경피혈양포화도（ SpO2）적변화、기도손상정도、술후인통화성음시아발생솔，분석기재수술조작급감경폐손상중적작용。결과도관치입정위일차성공솔위96．7％，측와위후경섬유지기관경검사발현유6례（20％）지기관투낭위치수조정；여쌍폐통기상비，단폐통기기간PEAK초승고，VT、R、ETCO2、SpO2변화불명현（ P균＞0．05）；기도손상정도평분위1．42분；술후인통발생솔40％，성음시아（반수인통）발생솔10％。결론NTLBB용우단폐통기，구유치입정위간단、조격효과학절、기도손상소、술후병발증저등우점，유조우제고식관암환자적수술급마취질량。
Objective To investigate the clinical value of applying a new type left-bronchial-blocker ( NTLBB ) for one-lung ventilation ( OLV) during the esophageal cancer surgery .Methods Thirty patients with esophageal cancer ( ASAⅠ-Ⅱ) were embedded the new type left-bronchial-blocker in order to achieve the right single lung ventilation and the left side collapse after anesthesia induction and thus to operate and reduce the lung injury .By observing the positioning cathe-terization success rate, peak airway pressure (PEAK) during OLV, ventilation (VT), respiratory frequency (R), breath out CO2 partial pressure ( ETCO2 ) , the change of the SpO 2 , damage degree of the airway and the incidence of postoperative sore throat and hoarse , we analyzed the effect of NTLBB during the surgery and reducing the lung injuries .Results The positioning catheterization success rate was 96.7%, and 6 patients needed adjusting position of bronchial tampon which were observed by lateral position FOB examination (20%).Compared with double lung ventilation , during OLV, PEAK was increased, but the changes of VT, R, ETCO2, SpO2 were not obvious (all P>0.05).Airway trauma score was 1.42. The incidence of postoperative follow-up hoarse ( accompanied by sore throat ) was 10%, and the incidence of sore throat was 40%.Conclusions NTLBB for OLV has the advantages of simple , precise positioning , small airway lesions and low complications , and helps to improve the quality of esophageal cancer surgery and anesthesia .
