摘要
目的比较Coopdech封堵支气管导管(Coopdech管)和双腔支气管导管(双腔管)用于胸椎结核患者经胸入路手术单肺通气麻醉的效果。方法选取2008年4月—2012年7月在本院择期全麻下行经胸入路病灶清除术联合胸椎后路内固定术的胸椎结核患者40例,将其随机分为Coopdech管组(A组)和双腔管组(B组),全身麻醉诱导后分别插入单腔加强气管导管和双腔管,A组在纤维支气管镜(纤支镜)引导下插入Coopdech管,两组均由纤支镜确定或调整导管位置。记录麻醉前(T1)、俯卧位后双肺通气15 min(T2)、侧卧位单肺通气15 min(T3)两组患者动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)及气道峰压增加率;改变体位后导管移位率;术后由骨科医师评价肺萎陷和术野暴露情况,由麻醉医师记录术后患者咽痛、声嘶情况。结果 (1)两组患者术中各时点PaO2、PaCO2及导管移位率比较,差异均无统计学意义(P>0.05);而A组气道峰压增加率低于B组〔(0.15±0.02)%与(0.36±0.03)%,P<0.05〕。(2)术中A组肺萎陷和术野暴露优17例,良3例,差0例;B组优19例,良1例,差0例,两组患者肺萎陷和术野暴露程度间无差异(P=0.626)。(3)术后A组咽痛、声嘶发生率20.0%(4/20),低于B组55.0%(11/20)(χ2=5.227,P=0.022)。结论在胸椎结核经胸入路手术时,Coopdech管可以安全地应用于单肺通气麻醉,且比双腔管能降低气道峰压增加率及术后咽痛、声嘶发生率。
Objective To compare the effect of Coopdech bronchial occluder and double - lumen tube for single - lung ventilation in thoracic tuberculosis patients undergoing transthoracic surgery. Methods A total of 40 thoracic tuberculosis patients who received transthoracie focal cleaning surgery combined with thoracic posterior internal fixation procedure during April 2008 to July 2012 in Hangzhou Red Cross Hospital were randomly divided into two groups： Coopdech bronchial occluder group （A group） and double- lumen tube group （B group） . All patients were treated under general anesthesia. Single -lumen strengthen endotracheal tube was inserted in A group, then Coopdech bronchial occluder was inserted in A group guided by fiber bronchoscope. Double - lumen tube was inserted in B group. Tube positions of both groups were adjusted and confirmed by fiber bronchoscope. PaO2 , PaCO2 and the airway peak pressure increasing rate were recorded before anesthesia （ T1 ） , two - lung ventilation 15 min at prone position （ T2 ） , one - lung ventilation at lateral position （ T3 ） . Tube translocation rates were also recorded. After the surgery, pulmonary collapse and operative field exposure were evaluated by orthopedists, pharyngalgia and hoarseness were recorded by anesthetist. Results There was no significant difference between two groups in PaO2 , PaCO2 and tube translocation rates （P 〉 0. 05 ） . The airway peak pressure increasing rate in A group [ （0. 15 ± 0. 02）% ] was lower than that （ （ 0. 36 ± 0. 03 ） % ] in B group （ P 〈 0. 05 ） . There was no significant difference between two groups in pulmonary collapse and operative field exposure degree （A group： excellent in 17 cases, good in 3 cases, poor in 0 case; B group： excellent in 19 cases, good in 1 case, poor in 0 case, P =0. 626） . The incidence of pharyngalgia and hoarseness in A group （20. 0% （4/20） was significantly lower than that [ 55.0% （11/20） ] in B group （ X2 = 5. 227, P = 0. 022） . Conclusion For thoracic tuberculosis patients who receive transthoracic focal cleaning surgery, Coopdech bronchial occluder can be used in single - lung ventilation safely. Compared with double - lumen tube, the airway peak pressure increasing rate and incidence of pharyngalgia and hoarseness were lower when using Coopdech bronchial occluder.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第3期292-295,共4页
Chinese General Practice
基金
杭州市卫生科技计划(2011A030)
