摘要
目的探讨支气管封堵器用于小切口微创心脏瓣膜手术的临床价值。方法选择2021年1月至2021年6月行微创心脏瓣膜手术的患者64例,年龄18~65周岁,按照随机数字表法,分为双腔支气管导管组(对照组,32例)和支气管封堵器组(试验组,32例)。观察并比较两组患者插管定位时间与肺萎陷效果、插管期间血流动力学的变化、单肺通气效果及并发症发生情况。结果与对照组[(272.03±46.65)s]相比,试验组插管定位的时间[(210.81±17.56)s]明显缩短(P<0.05);两组术中肺萎陷质量相近,各时间点的PaO_(2)和PaCO_(2)差异无统计学意义(P>0.05)。两组患者气管插管后心率(HR)及平均动脉压(MAP)较插管前(T_(1))均有所上升,但相比于对照组,试验组插管即刻(T_(2))和插管后1分钟(T_(3))HR较慢[(88.72±11.42)次/min vs(95.16±9.87)次/min,(83.09±11.13)次/min vs(89.44±10.15)次/min;均P<0.05],T_(2)和T_(3)时的MAP也较低[(86.0±11.13)mmHg vs(95.19±10.04)mmHg,(82.34±10.86)mmHg vs(90.56±9.79)mmHg;均P<0.05]。单肺通气后10分钟(T5)及体外循环结束后单肺通气10分钟(T6)时,两组患者单肺通气期间气道峰压(P_(peak))和气道平台压(P_(plat))比单肺通气前(T_(4))有所升高,且对照组气道压升高更为明显[(21.50±2.41)cmH_(2)O vs(24.69±3.48)cmH_(2)O,(22.25±2.26)cmH_(2)O vs(25.19±3.34)cmH_(2)O;均P<0.05]。试验组较对照组术后咽痛(6.25%vs 18.75%)和声音嘶哑(3.13%vs 15.63%)发生率低,P<0.05。结论支气管封堵器可产生良好的单肺通气效果,操作简单方便,插管刺激小,并能明显降低术后咽痛和声嘶的发生率,可安全有效地用于微创心脏瓣膜手术。
Objective To investigate the clinical value of bronchial blockers in small-incision minimally invasive cardiac valve surgery.Methods Sixty-four patients,aged 18-65 years old,who underwent minimally invasive cardiac valve surgery in the Department of Cardiovascular Surgery at our hospital from January 2021 to June 2021 were selected.According to the method of one-lung ventilation during surgery,the patients were randomly divided into double-lumen bronchial tube group(control group,32 cases)and bronchial blocker group(experimental group,32 cases).The hemodynamic changes during intubation,the effectiveness of one-lung ventilation and the incidence of complications were reviewed and compared between the two groups.Results Compared to control group[(272.03±46.65)s],the intubation positioning time of experimental group[(210.81±17.56)s]was significantly shorter(P<0.05).The quantity of pulmonary atrophy was almost the same in both groups,and there was no statistically significant difference in PaO_(2) and PaCO_(2) at all time points(P>0.05).The heart rate(HR)and mean arterial pressure(MAP)were increased in both groups after intubation compared to before intubation(T_(1)).However,the HR were slower in experimental group immediately after intubation(T_(2))and 1 min after intubation(T_(3))[(88.72±11.42)beats/min vs(95.16±9.87)beats/min,(83.09±11.13)beats/min vs(89.44±10.15)beats/min,both P<0.05],and the MAP at T_(2) and T_(3) were lower[(86.0±11.13)mmHg vs(95.19±10.04)mmHg,(82.34±10.86)mmHg vs(90.56±9.79)mmHg,both P<0.05].Compared with before one-lung ventilation(T_(4)),the peak airway pressure(P_(peak))and plateau airway pressure(P_(plat))were also increased in both groups at 10 min after one-lung ventilation(T5)and at 10 min after one-lung ventilation at the end of cardiopulmonary bypass(T6),with a more significant increase in control group[(21.50±2.41)cmH_(2)O vs(24.69±3.48)cmH_(2)O,(22.25±2.26)cmH_(2)O vs(25.19±3.34)cmH_(2)O,both P<0.05].The incidence of postoperative sore throat(6.25%vs 18.75%)and hoarsen
作者
和姗
宋大为
马治
郑钰婷
孔治东
周荣胜
HE Shan;SONG Dawei;MA Zhi;ZHENG Yuting;KONG Zhidong;ZHOU Rongsheng(Department of Anesthesiology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)
出处
《大连医科大学学报》
CAS
2024年第3期200-205,共6页
Journal of Dalian Medical University
基金
陕西省重点研发计划一般项目(2019SF-154)。
关键词
支气管封堵器
双腔支气管导管
微创手术
心脏瓣膜
bronchial blocker
double-lumen bronchial tube
minimally invasive surgery
heart valve
