可视喉罩联合支气管封堵器在...腔镜肺叶部分切除术中的应用_王桂娟.pdf

通讯作者:李希明,E-mail:作者简介:王桂娟(1995)女,潍坊医学院麻醉学院研究生在读,主要从事肺保护策略方面的学习。文章编号:1009-6612(2022)12-0938-06DOI:10.13499/ki.fqjwkzz.2022.12.938论论 著著可视喉罩联合支气管封堵器在胸腔镜肺叶部分切除术中的应用王桂娟1,麻晓晨2,杜胜杰3,管 伟3,李希明3(1.潍坊医学院麻醉学院,山东 潍坊,261053;2.锦州医科大学临沂市人民医院培养基地;3.临沂市人民医院麻醉科)【摘要】目的:探讨可视喉罩联合支气管封堵器在胸腔镜肺叶部分切除术中的可行性及优势。方法:选择 2021 年 12 月至 2022 年 5 月于全麻下行胸腔镜肺叶部分切除术的 80 例患者,按照随机数字表法分为可视喉罩联合支气管封堵器组(实验组)与双腔支气管导管组(对照组),每组 40 例。对比分析两组患者术后咽痛声嘶等插管不良事件发生率。记录两组麻醉诱导前(T0)、诱导后(T1)、插入喉罩或气管导管即刻(T2)、插入喉罩或气管导管后 2 min(T3)、拔除喉罩或气管导管即刻(T4)、拔除喉罩及气管导管后2 min(T5)的平均动脉压、心率,记录双肺通气5 min(T6)、单肺通气5 min(T7)、术毕恢复双肺通气 5 min(T8)后的气道平台压(P1、P2、P3)、血氧饱和度。比较两组插管定位时间、手术时间、单肺通气时间、麻醉时间、住院时间、单肺通气 10 min 肺萎陷情况、导管移位发生率、患者 Aldrete 苏醒评分、术前与术后第 1 天恢复质量评分(QoR-15)及术后满意度。结果:实验组与对照组各剔除 1 例,共纳入 78 例患者。实验组咽痛(5.1%vs.43.6%)、声嘶发生率(2.6%vs.25.6%)低于对照组,差异有统计学意义(P0.05)。T2、T4、T5时,实验组平均动脉压低于对照组(P0.05),T6、T7、T8时,实验组气道平台压(P1、P2、P3)低于对照组(P0.05);实验组术后第 1 天 QoR-15 评分、住院时间、术后满意度优于对照组(P0.05)。结论:可视喉罩联合支气管封堵器可满足胸腔镜肺叶部分切除术中的单肺通气要求,减少插管相关不良反应,降低围术期循环波动,缩短住院时间,提高患者术后满意度,促进患者快速康复。【关键词】可视喉罩;支气管封堵器;单肺通气;肺切除术;胸腔镜检查中图分类号:R614 文献标识码:AApplication of visual laryngeal mask combined with bronchial occluder in thoracoscopic partial lobectomy WANG Gui-juan1,MA Xiao-chen2,DU Sheng-jie3,et al.1.School of Anesthesiology,Weifang Medical University,Weifang 261053,China;2.GraduateTraining Base of Linyi Peoples Hospital,Jinzhou Medical University;3.Department of Anesthesiology,Linyi Peoples Hospital【Abstract】Objective:To explore the feasibility and advantages of visual laryngeal mask combined with bronchial occluder inthoracoscopic partial lobectomy.Methods:Eighty patients who underwent thoracoscopic partial lobectomy under general anesthesia fromDec.2021 to May 2022 were randomly divided into visual laryngeal mask combined with bronchial occluder group(experimental group)and double-lumen bronchial catheterization group(control group)with 40 cases in each group.The incidence of postoperative intuba-tion adverse events such as pharyngalgia and hoarseness were analyzed and compared between the two groups.Mean arterial pressure,heart rate were recorded before anesthesia induction(T0),after induction(T1),immediately after insertion of laryngeal mask or endo-tracheal tube(T2),2 min(T3)after insertion of laryngeal mask or endotracheal tube,immediately after removal of laryngeal mask orendotracheal tube(T4),and 2 min(T5)after removal of laryngeal mask or endotracheal tube.The airway plateau pressures(P1,P2,P3)and oxygen saturation were recorded after 5 min of double-lung ventilation(T6),5 min of single-lung ventilation(T7),and 5 minafter recovery of double-lung ventilation after surgery(T8).The intubation positioning time,operation time,one-lung ventilation time,anesthesia time,hospital stay,10-min one-lung ventilation lung collapse,the incidence of catheter displacement,the Aldrete recoveryscore,15-item quality of recovery score before and 1 day after surgery,and postoperative satisfaction were compared between the twogroups.Results:One patient was excluded in experimental group and one in control group,and 78 patients were included.The inci-dences of sore throat and hoarseness in the experimental group were 5.1%and 2.6%,respectively,which were significantly lower thanthose in the control group(43.6%and 25.6%),and the difference was statistically significant(P0.05).Compared with controlgroup,experimental group had lower mean arterial pressures at T2,T4,T5(P0.05),lower airway platform pressure(P1,P2,P3)at T6,T7,T8(P0.05),higher QoR-15 score on the 1st day after operation(P0.05),shorter hospital stay and higher postoperative satisfac-839第 27 卷第 12 期2022 年 12 月 腹 腔 镜 外 科 杂 志JOURNAL OF LAPAROSCOPIC SURGERY Vol.27,No.12Dec.2022tion(P0.05).Conclusions:Visual laryngeal mask com-bined with bronchial occluder can meet the requirements of one-lung ventilation in thoracoscopic partial lobectomy,and can reduceadverse reactions related to intubation,reduce perioperative circulatory fluctuations,shorten hospital stay,improve patients satisfaction,and promote the rapid recovery of patients.【Key words】Visual laryngeal mask;Bronchial occluder;One-lung ventilation;Pneumonectomy;Thoracoscopy 胸腔镜手术具有损伤小、手术视野宽阔、术后康复快等优点,已在临床得到广泛开展1。肺隔离技术已成为胸腔镜手术的必要条件。目前双腔支气管插管是临床工作中肺隔离技术最常用的方法之一2,但传统双腔支气管导管材质硬,外径较粗,内径较小,单肺通气时气道阻力大,往往会对气道造成不同程度的损伤,带来一系列插管相关不良反应。近年,单腔支气管导管联合支气管封堵器广泛应用于胸腔镜单肺通气手术中,虽然在一定程度上减少了对咽喉部的刺激,但仍然存在血流动力学波动大、咽痛声嘶等插管风险3-4。喉罩具有损伤小、刺激轻的特点,侯涛等将 I-gel 喉罩联合 Coopdech 支气管封堵器应用于胸科手术中,取得了很好的临床效果。为减少插管相关风险,提高患者术后舒适度,促进快速康复,本研究于胸腔镜肺部分切除术中采用可视喉罩联合支气管封堵器,探讨其在单肺通气手术中的可行性及优势,以期为临床提供参考。1 资料与方法1.1 临床资料 本研究通过医院伦理委员会批准,获得患者及家属的知情同意。选择 2021 年 12 月至 2022 年 5 月在我院行胸腔镜下肺部分切除术的 80 例患者,18 65 岁,性别不限,ASA 分级 级,BMI0.05)。实验组:根据患者体重选择合适的喉罩型号。使用注射器抽空气囊内气体后塑形,以执笔式将润滑后的可视喉罩沿患者口腔中线往下插入,喉罩到位后可感觉到明显阻力,注入适量空气后,通过喉镜观察,视频可见整个声门,则表明喉罩对位良好5。在视角可调视频喉镜的监视下置入支气管封堵器,再用纤维支气管镜定位固定。对照组:根据患者术前胸部 CT 气管测量内径选择合适的导管型号。用普通可视喉镜进行双腔支气管插管,用纤维支气管镜定位后固定。喉罩置入、支气管封堵器放置、气管插管均由一位操作熟练的主治医师完成。1.3 麻醉方法 常规术前禁饮、禁食 8 h。入室后开放外周静脉,吸氧,常规行心电图、血氧饱和度、心率、脑电双频指数、血压监测,用 1%的利多卡因进行局部浸润后行桡动脉穿刺置管术测量有创动脉血压。诱导前予以盐酸右美托咪定 0.5 g/kg(15 min 内泵注完毕)。麻醉