摘要
目的评价气管导管外置支气管封堵器用于患儿单肺通气的效果。方法择期胸外科手术患儿38例,拟于全身麻醉下完成。年龄4~8岁,体重14.0~28.6kg,ASA分级Ⅰ或Ⅱ级,性别不限。根据患儿胸部X线片锁骨胸骨水平气管内径,选择气管导管型号,麻醉诱导结束后,可视喉镜下将支气管封堵器远端弯曲指向目标支气管置入,至遇到阻力,于可视喉镜下置入预先选定气管导管插入,置入深度为(年龄÷2+12)cm,经气管导管纤支镜调节支气管封堵器位置,使其蓝色套囊上缘位于隆突下0.5~1.0cm。于单肺通气前即刻(T1)和单肺通气后30min(T1)、单肺通气结束时(T3)记录MAP、HR、SpO2和气道压力(Paw),并行动脉血气分析,记录PaCO2和PaO2。记录气管插管时间、一次性气管插管成功情况、支气管封堵器移位情况及术后喉痛声嘶的发生情况。参照Campos标准评价肺萎陷情况。结果与T1时比较,T2,3,时患儿PaO2降低,Paw升高(P<0.05),HR、MAP、PaCO,和Sp0,差异无统计学意义(P>0.05)。患儿气管插管时间为(185±38)s,一次性气管插管成功率、支气管封堵器移位率、肺萎陷优良率及喉痛声嘶的发生率分别为95%、16%、100%和11%。结论气管导管外置支气管封堵器可有效用于患儿单肺通气。
Objective To evaluate the efficacy of bronchial blocker outside the endotracheal tube for one-lung ventilation (OLV) in pediatric patients. Methods Thirty-eight American Society of Anesthe-siologists physical status ⅠorⅡ patients of both sexes, aged 4-8 yr, weighing 14. 0-28. 6 kg, scheduled for elective thoracic surgery under general anesthesia, were enrolled in this study. The size of tracheal tube was selected according to the endotracheal diameter at the level of clavicle and sternum on chest X-ray. Af-ter anesthesia induction, the distal end of the bronchial blocker was bent toward the target bronchus with a videolaryngoscope and then inserted until resistance was felt, and the preselected tracheal tube was inserted with a videolaryngoscope at a depth of (age∕2+12) cm. The position of the bronchial blocker was adjusted using a bronchofiberscope so that the upper edge of the blue cuff was 0. 5-1. 0 cm below the carina. The heart rate, mean arterial pressure, SpO2and airway pressure were recorded, arterial blood gas analysis was performed, and PaCO2and PaO2were recorded immediately before OLV (T1), at 30 min after OLV (T2) and at the end of OLV (T3). The intubation time, success rate of intubation at first attempt, displacement of bronchial blocker and occurrence of postoperative laryngeal pain and hoarseness were recorded. The pul-monary collapse was evaluated according to the standard described by Campos.Results Compared with the baseline at T1, PaO2was significantly decreased and airway pressure was increased at T2,3(P<0. 05), and no significant change was found in heart rate, mean arterial pressure, PaCO2or SpO2at T2,3( P>0. 05). The average intubation time was (185±38) s. The success rate of intubation at first attempt, rate of bronchial blocker displacement, excellent and good rates of pulmonary collapse and incidence of laryngeal pain and hoarseness were 95%, 16%, 100% and 11%, respectively. Conclusion Bronchial blocker outside the endotracheal tube can be effectively used for OLV in pediatric patients.
作者
信文启
闫增
张森
杨晴
李爱香
张义轩
Xin Wenqi;Yah Zeng;Zhang Sen;Yang Oing;Li Aixiang;Zhang Yixuan(Department of Anesthesiology,Huaihe Hospital Affiliated to Henan University,Kaifeng 475000,He'nan,China;Department of Anesthesiology,Children's Hospital of Kaifeng City,Kaifeng 475000,Henan,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2018年第7期863-865,共3页
Chinese Journal of Anesthesiology
关键词
插管法
气管内
呼吸
人工
儿童
Intubation,intratraeheal
Respiration,artificial
Child
